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General NPI Number Information
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NPI Number | 1639273014
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Entity Type | Organization
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Legal Business Name | AMERICAN HEALTH NETWORK OF INDIANA, LLC
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 101 S. LIBERTY STREET
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City | RUSSIAVILLE
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State | IN
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Zip | 46979
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Country | US
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Telephone | 765-883-2273
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Fax | 765-883-5168
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Provider Business Mailing Address
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Address Line | PO BOX 400
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City | RUSSIAVILLE
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State | IN
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Zip | 46979-0400
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Country | US
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Telephone | 765-883-2273
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Fax | 765-883-5168
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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 | MD
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Telephone | 317-580-6307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085N0904X
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Taxonomy Name | Nuclear Radiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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