Provider Demographics
NPI: | 1861502312 |
---|---|
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: | 18051 RIVER AVE |
Mailing Address - Street 2: | SUITE 200 |
Mailing Address - City: | NOBLESVILLE |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46062-7091 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 317-758-4477 |
Mailing Address - Fax: | 317-758-0936 |
Practice Address - Street 1: | 611 E 10TH ST |
Practice Address - Street 2: | |
Practice Address - City: | SHERIDAN |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46069-9106 |
Practice Address - Country: | US |
Practice Address - Phone: | 317-758-4477 |
Practice Address - Fax: | 317-758-0936 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | AMERICAN HEALTH NETWORK OF INDIANA, LLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-08-30 |
Last Update Date: | 2017-06-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 2084P2900X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Pain Medicine | Group - Multi-Specialty |
No | 2085N0904X | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | Group - Multi-Specialty |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 2085U0001X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208VP0000X | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | Group - Multi-Specialty |
No | 208VP0014X | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | Group - Multi-Specialty |
No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | 0828280004 | Other | DMERC |
IN | 200130880A | Medicaid | |
IN | 151550 | Medicare PIN | |
IN | 200130880A | Medicaid |