Provider Demographics
NPI:1316354368
Name:AMERICAN HEALTH NETWORK OF INDIANA
Entity type:Organization
Organization Name:AMERICAN HEALTH NETWORK OF INDIANA
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:317-580-6314
Mailing Address - Street 1:10689 N PENNSYLVANIA ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280-1070
Mailing Address - Country:US
Mailing Address - Phone:317-580-6307
Mailing Address - Fax:317-580-6307
Practice Address - Street 1:775 MANCHESTER AVE STE B
Practice Address - Street 2:FORD METER BOX - SUPERIOR HEALTH
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-1420
Practice Address - Country:US
Practice Address - Phone:260-569-3757
Practice Address - Fax:260-569-3586
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN HEALTH NETWORK OF INDIANA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031965A332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site