1124113063 NPI number — AMERICAN HEALTH NETWORK OF INDIANA, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124113063 NPI number — AMERICAN HEALTH NETWORK OF INDIANA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN HEALTH NETWORK OF INDIANA, LLC
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:
1124113063
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4850 CENTURY PLAZA ROAD
Provider Second Line Business Mailing Address:
SUITE 180
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-839-9833
Provider Business Mailing Address Fax Number:
317-839-7549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 SOUTHFIELD DRIVE
Provider Second Line Business Practice Location Address:
SUITE 1210
Provider Business Practice Location Address City Name:
PLAINFIELD
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-839-9833
Provider Business Practice Location Address Fax Number:
317-839-7549
Provider Enumeration Date:
10/04/2006

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:
317-580-6307

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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