Provider Demographics
NPI:1558394734
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 1:5900 PARKWOOD PL
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-1216
Mailing Address - Country:US
Mailing Address - Phone:614-794-4500
Mailing Address - Fax:147-944-9766
Practice Address - Street 1:370 CLINE AVE #B3
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1057
Practice Address - Country:US
Practice Address - Phone:419-756-9995
Practice Address - Fax:419-756-1135
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN HEALTH NETWORK OF OHIO, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-09
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
302F00000X, 207R00000X, 363AM0700X, 363LA2200X, 207R00000X
OH363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Yes302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0150616Medicaid
OH0150616Medicaid
OHAM9277061Medicare PIN
OHCB3005OtherRAIL ROAD MEDICARE