Provider Demographics
NPI:1508885807
Name:AMERICAN HEALTH NETWORK OF OHIO, LLC
Entity Type:Organization
Organization Name:AMERICAN HEALTH NETWORK OF OHIO, LLC
Other - Org Name:AMERICAN HEALTH NETWORK OF OHIO PROFESSIONAL CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:VP OPERATIONS OHIO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:COURTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-794-5053
Mailing Address - Street 1:104 N UNION ST STE B
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1706
Mailing Address - Country:US
Mailing Address - Phone:740-362-3696
Mailing Address - Fax:740-362-5010
Practice Address - Street 1:104 NORTTH UNION STREET SUITE B
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1706
Practice Address - Country:US
Practice Address - Phone:740-362-3696
Practice Address - Fax:740-362-5010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN HEALTH NETWORK OH OHIO, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-18
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2365999Medicaid
OH2365999Medicaid