MEDICARE: AMERICAN HEALTH NETWORK OF INDIANA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1255618195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN HEALTH NETWORK OF INDIANA, LLC

Provider Business Mailing Address
First Line	:	3610 N BRIARWOOD LN
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47304-5219
Country	:	US
Telephone Number	:	765-284-3879
Fax Number	:

Provider Business Practice Location Address
First Line	:	3610 N BRIARWOOD LN
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47304-5219
Country	:	US
Telephone Number	:	765-284-3879
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	BEN H PARK
Credential	:	MD
Telephone Number	:	317-580-6314

Provider Enumeration Date	:	11/07/2011
Last Update Date	:	06/22/2017

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