Healthcare Provider Details

I. General information

NPI: 1801815857
Provider Name (Legal Business Name): AMERICAN HEALTH NETWORK OF OHIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W CENTRAL AVE
DELAWARE OH
43015-1421
US

IV. Provider business mailing address

550 W CENTRAL AVE
DELAWARE OH
43015-1421
US

V. Phone/Fax

Practice location:
  • Phone: 740-363-1904
  • Fax: 740-363-5288
Mailing address:
  • Phone: 403-631-9047
  • Fax: 740-363-5288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BRAD A COURTER
Title or Position: VP OPERATIONS OHIO
Credential:
Phone: 614-794-5053