Provider Demographics
NPI:1578658423
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:317-580-6307
Mailing Address - Street 1:3743 LANDMARK DR
Mailing Address - Street 2:STE 200
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-6656
Mailing Address - Country:US
Mailing Address - Phone:844-424-3668
Mailing Address - Fax:317-575-6909
Practice Address - Street 1:3750 LANDMARK DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905
Practice Address - Country:US
Practice Address - Phone:765-448-4511
Practice Address - Fax:765-447-8375
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN HEALTH NETWORK OF INDIANA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-04
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0828280023Medicare NSC