1316354368 NPI number — AMERICAN HEALTH NETWORK OF INDIANA

Table of content: (NPI 1316354368)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316354368 NPI number — AMERICAN HEALTH NETWORK OF INDIANA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN HEALTH NETWORK OF INDIANA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316354368
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10689 N PENNSYLVANIA ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46280-1070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-580-6307
Provider Business Mailing Address Fax Number:
317-580-6307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
775 MANCHESTER AVE STE B
Provider Second Line Business Practice Location Address:
FORD METER BOX - SUPERIOR HEALTH
Provider Business Practice Location Address City Name:
WABASH
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46992-1420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-569-3757
Provider Business Practice Location Address Fax Number:
260-569-3586
Provider Enumeration Date:
07/22/2014

Additional Information

Authorized Official

Authorized Official Last Name:
PARK
Authorized Official First Name:
BEN
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
317-580-6314

Provider Taxonomy Codes

  • Taxonomy code: 332900000X , with the licence number:  01031965A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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