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General NPI Number Information
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NPI Number | 1679502686
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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 | 07/02/2006
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Last Update Date | 03/24/2014
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Provider Practice Location Address
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Address Line | 190 INKS DRIVE
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City | WINCHESTER
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State | IN
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Zip | 47394-8283
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Country | US
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Telephone | 317-580-6429
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Fax |
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Provider Business Mailing Address
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Address Line | 190 INKS DRIVE
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City | WINCHESTER
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State | IN
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Zip | 47394-8283
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Country | US
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Telephone |
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Fax |
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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 |
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License Number State |
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