Basic Information
| Provider Information | |||||||||
| NPI: | 1609970219 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMERICAN HEALTH NETWORK OF INDIANA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 660242 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462660001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177369576 | ||||||||
| FaxNumber: | 3177387833 | ||||||||
| Practice Location | |||||||||
| Address1: | 1125 W JEFFERSON ST | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461312140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177363576 | ||||||||
| FaxNumber: | 3177367833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2006 | ||||||||
| LastUpdateDate: | 01/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | PARK | ||||||||
| AuthorizedOfficialFirstName: | BEN | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 3175806307 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | AMERICAN HEALTH NETWORK OF INDIANA, LLC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.