Basic Information
| Provider Information | |||||||||
| NPI: | 1518990787 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMERICAN HEALTH NETWORK OF OHIO, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3823 TRUEMAN CT | ||||||||
| Address2: | |||||||||
| City: | HILLIARD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430262496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148769558 | ||||||||
| FaxNumber: | 6148769570 | ||||||||
| Practice Location | |||||||||
| Address1: | 3823 TRUEMAN COURT | ||||||||
| Address2: | |||||||||
| City: | HILLIARD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430262496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148769558 | ||||||||
| FaxNumber: | 6148769570 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 05/25/2022 | ||||||||
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| AuthorizedOfficialLastName: | COURTER | ||||||||
| AuthorizedOfficialFirstName: | BRAD | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OPERATIONS OHIO | ||||||||
| AuthorizedOfficialTelephone: | 6147945053 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | AMERICAN HEALTH NETWORK OF OHIO, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 05/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 227800000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | 2278G1100X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | General Care | 363LF0000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0134241 | 05 | OH | MEDICAID |