1770621161 NPI number — AMERICAN HEALTH NETWORK OF INDIANA, LLC

Table of content: (NPI 1770621161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770621161 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:
1770621161
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13000 N MERIDIAN ST STE 100
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:
46032-1404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-582-1841
Provider Business Mailing Address Fax Number:
317-582-1891

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13000 N MERIDIAN ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARMEL
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46032-1404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-580-1841
Provider Business Practice Location Address Fax Number:
317-582-1891
Provider Enumeration Date:
02/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BENSON
Authorized Official First Name:
MARK
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CHIEF PHYSICIAN EXECUTIVE
Authorized Official Telephone Number:
317-580-6304

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200189840A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 690008997 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com