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General NPI Number Information
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NPI Number | 1316354368
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Entity Type | Organization
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Legal Business Name | AMERICAN HEALTH NETWORK OF INDIANA
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Dates
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Enumeration Date | 07/22/2014
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Last Update Date | 07/22/2014
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Provider Practice Location Address
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Address Line | 775 MANCHESTER AVE STE B FORD METER BOX - SUPERIOR HEALTH
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City | WABASH
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State | IN
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Zip | 46992-1420
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Country | US
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Telephone | 260-569-3757
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Fax | 260-569-3586
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Provider Business Mailing Address
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Address Line | 10689 N PENNSYLVANIA ST SUITE 200
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City | INDIANAPOLIS
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State | IN
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Zip | 46280-1070
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Country | US
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Telephone | 317-580-6307
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Fax | 317-580-6307
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | BEN H. PARK
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Credential | M.D.
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Telephone | 317-580-6314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | 01031965A
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License Number State | IN
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