Provider Demographics
NPI:1447361829
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 1:6820 PARKDALE PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-6601
Mailing Address - Country:US
Mailing Address - Phone:765-359-2088
Mailing Address - Fax:765-359-2237
Practice Address - Street 1:1706 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-1033
Practice Address - Country:US
Practice Address - Phone:765-359-2088
Practice Address - Fax:765-359-2237
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN HEALTH NETWORK OF INDIANA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100133190LMedicaid
DC9693Medicare PIN
IN222750Medicare PIN