Healthcare Provider Details

I. General information

NPI: 1558394726
Provider Name (Legal Business Name): AMERICAN HEALTH NETWORK OF OHIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 COLUMBUS ROAD
FREDERICKTOWN OH
43019-1266
US

IV. Provider business mailing address

122 COLUMBUS RD
FREDERICKTOWN OH
43019-1266
US

V. Phone/Fax

Practice location:
  • Phone: 740-694-1261
  • Fax: 740-694-7145
Mailing address:
  • Phone: 740-694-1261
  • Fax: 740-694-7145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

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