Provider Demographics
NPI:1376668780
Name:AMERICAN HEALTH NETWORK OF INDIANA, LLC
Entity Type:Organization
Organization Name:AMERICAN HEALTH NETWORK OF INDIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-580-6314
Mailing Address - Street 1:4850 CENTURY PLAZA RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5476
Mailing Address - Country:US
Mailing Address - Phone:317-328-6730
Mailing Address - Fax:317-388-8457
Practice Address - Street 1:6820 PARKDALE PL
Practice Address - Street 2:SUITE 105
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-6601
Practice Address - Country:US
Practice Address - Phone:317-328-6730
Practice Address - Fax:317-388-8457
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN HEALTH NETWORK OF INDIANA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-21
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Multi-Specialty
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CH1019Medicare PIN
IN151510Medicare PIN