1205405925 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 1205405925 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:
1205405925
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2021
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 STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46280-1099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-580-6372
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4101 TECHNOLOGY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ALBANY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47150-8548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-941-4500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/18/2021

Additional Information

Authorized Official

Authorized Official Last Name:
BENSON
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
INTERIM CEO/MEDICAL DIRECTOR
Authorized Official Telephone Number:
317-580-6304

Provider Taxonomy Codes

  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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