Provider Demographics
NPI:1780957191
Name:AMERICAN MEDICAL HEALTH NETWORK, INC
Entity type:Organization
Organization Name:AMERICAN MEDICAL HEALTH NETWORK, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTOINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TEVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-923-2444
Mailing Address - Street 1:3737 N MERIDIAN ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-4348
Mailing Address - Country:US
Mailing Address - Phone:317-923-2444
Mailing Address - Fax:317-923-8758
Practice Address - Street 1:3737 N MERIDIAN ST
Practice Address - Street 2:SUITE 410
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4348
Practice Address - Country:US
Practice Address - Phone:317-923-2444
Practice Address - Fax:317-923-8758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM100068503Medicare PIN