Healthcare Provider Details

I. General information

NPI: 1124113063
Provider Name (Legal Business Name): AMERICAN HEALTH NETWORK OF INDIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 06/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SOUTHFIELD DRIVE SUITE 1210
PLAINFIELD IN
46168
US

IV. Provider business mailing address

4850 CENTURY PLAZA ROAD SUITE 180
INDIANAPOLIS IN
46254
US

V. Phone/Fax

Practice location:
  • Phone: 317-839-9833
  • Fax: 317-839-7549
Mailing address:
  • Phone: 317-839-9833
  • Fax: 317-839-7549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BEN H PARK
Title or Position: PRESIDENT AND CEO
Credential: MD
Phone: 317-580-6307