Provider Demographics
| NPI: | 1245334259 |
|---|---|
| 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: | 4850 CENTURY PLAZA RD |
| Mailing Address - Street 2: | SUITE 180 |
| Mailing Address - City: | INDIANAPOLIS |
| Mailing Address - State: | IN |
| Mailing Address - Zip Code: | 46254-5476 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 317-272-7013 |
| Mailing Address - Fax: | 317-272-7007 |
| Practice Address - Street 1: | 1115 RONALD REAGAN PKWY |
| Practice Address - Street 2: | SUITE 100 |
| Practice Address - City: | AVON |
| Practice Address - State: | IN |
| Practice Address - Zip Code: | 46123-6910 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 317-272-7013 |
| Practice Address - Fax: | 317-272-7007 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | AMERICAN HEALTH NETWORK OF INDIANA, LLC |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2006-09-11 |
| Last Update Date: | 2008-01-08 |
| 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 |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| CH0751 | Medicare PIN | ||
| IN | 228250 | Medicare PIN |
