Provider Demographics
NPI:1770621161
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:CHIEF PHYSICIAN EXECUTIVE
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 1:13000 N MERIDIAN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1404
Mailing Address - Country:US
Mailing Address - Phone:317-582-1841
Mailing Address - Fax:317-582-1891
Practice Address - Street 1:13000 N MERIDIAN ST STE 100
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1404
Practice Address - Country:US
Practice Address - Phone:317-580-1841
Practice Address - Fax:317-582-1891
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN HEALTH NETWORK OF INDIANA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-01
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200189840AMedicaid
IN690008997OtherRAILROAD MEDICARE
IN165160Medicare PIN
690008997Medicare PIN