Healthcare Provider Details

I. General information

NPI: 1295204154
Provider Name (Legal Business Name): AMERICAN HEALTH NETWORK OF INDIANA CARE ORGANIZATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10689 N PENNSYLVANIA ST STE 200
INDIANAPOLIS IN
46280-1099
US

IV. Provider business mailing address

10689 N PENNSYLVANIA ST STE 200
INDIANAPOLIS IN
46280-1099
US

V. Phone/Fax

Practice location:
  • Phone: 317-580-6309
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BEN PARK
Title or Position: PRESIDENT AND CEO
Credential: MD
Phone: 317-580-6314