Provider Demographics
NPI:1710084116
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:INTERIM CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:317-580-6304
Mailing Address - Street 1:1111 RONALD REAGAN PKWY STE B1500
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7085
Mailing Address - Country:US
Mailing Address - Phone:317-217-2244
Mailing Address - Fax:317-217-2249
Practice Address - Street 1:1111 RONALD REAGAN PKWY STE B1500
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7085
Practice Address - Country:US
Practice Address - Phone:317-217-2244
Practice Address - Fax:317-217-2249
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN HEALTH NETWORK OF INDIANA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0828280027Medicare NSC