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 |