Provider Demographics
NPI:1477970440
Name:AMERICAN HEALTH NETWORK OF INDIANA, LLC
Entity Type:Organization
Organization Name:AMERICAN HEALTH NETWORK OF INDIANA, LLC
Other - Org Name:AMERICAN HEALTH NETWORK OF INDIANA, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
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 1:2625 N MORTON ST
Mailing Address - Street 2:KYB HEALTH AND WELLNESS CLINIC
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-8820
Mailing Address - Country:US
Mailing Address - Phone:317-736-2163
Mailing Address - Fax:
Practice Address - Street 1:2625 N MORTON ST
Practice Address - Street 2:KYB HEALTH AND WELLNESS CLINIC
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-8820
Practice Address - Country:US
Practice Address - Phone:317-736-2163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN HEALTH NETWORK OF INDIANA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty