Provider Demographics
NPI:1821390709
Name:AMERICAN HEALTH INSTITUTE, INC.
Entity Type:Organization
Organization Name:AMERICAN HEALTH INSTITUTE, INC.
Other - Org Name:INTERNATIONAL COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EROMONSELE
Authorized Official - Middle Name:O
Authorized Official - Last Name:IDAHOSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-602-3558
Mailing Address - Street 1:3737 N MERIDIAN ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-4348
Mailing Address - Country:US
Mailing Address - Phone:317-602-3558
Mailing Address - Fax:317-927-9779
Practice Address - Street 1:3737 N MERIDIAN ST
Practice Address - Street 2:SUITE 404
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4348
Practice Address - Country:US
Practice Address - Phone:317-602-3558
Practice Address - Fax:317-927-9779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-25
Last Update Date:2010-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057350A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center