Provider Demographics
NPI: | 1831236272 |
---|---|
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: | VP PRIMARY CARE OPERATIONS IN/OH |
Authorized Official - Prefix: | |
Authorized Official - First Name: | BRAD |
Authorized Official - Middle Name: | ALAN |
Authorized Official - Last Name: | COURTER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 614-794-5053 |
Mailing Address - Street 1: | 7440 WOODLAND DR STE 200 |
Mailing Address - Street 2: | |
Mailing Address - City: | INDIANAPOLIS |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46278-1720 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 317-580-6309 |
Mailing Address - Fax: | 317-580-6309 |
Practice Address - Street 1: | 7440 WOODLAND DR STE 200 |
Practice Address - Street 2: | |
Practice Address - City: | INDIANAPOLIS |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46278-1720 |
Practice Address - Country: | US |
Practice Address - Phone: | 317-580-6309 |
Practice Address - Fax: | 317-580-6309 |
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: | 2024-08-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207ZP0105X | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine | Group - Multi-Specialty |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2081P2900X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
No | 207RS0012X | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | 151560 | Medicare PIN |