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
1	207R00000X	Internal Medicine Physician
2	207RH0003X	Hematology & Oncology Physician
3	207V00000X	Obstetrics & Gynecology Physician
4	207X00000X	Orthopaedic Surgery Physician
5	208100000X	Physical Medicine & Rehabilitation Physician
6	2084N0400X	Neurology Physician
7	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician
8	2085N0904X	Nuclear Radiology Physician
9	2085R0202X	Diagnostic Radiology Physician
10	2085U0001X	Diagnostic Ultrasound Physician
11	208600000X	Surgery Physician
12	208VP0000X	Pain Medicine Physician
13	208VP0014X	Interventional Pain Medicine Physician
14	332B00000X	Durable Medical Equipment & Medical Supplies
15	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CG9692	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0828280003	OTHER	IN	DMERC

General Provider Information

NPI Number	:	1588773154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN HEALTH NETWORK OF INDIANA, LLC

Provider Business Mailing Address
First Line	:	18051 RIVER AVE
Second Line	:	SUITE 200
City	:	NOBLESVILLE
State	:	IN
Zip	:	46062-7091
Country	:	US
Telephone Number	:	317-773-0002
Fax Number	:	317-776-6095

Provider Business Practice Location Address
First Line	:	10995 ALLISONVILLE RD
Second Line	:	SUITE 100
City	:	FISHERS
State	:	IN
Zip	:	46038-2616
Country	:	US
Telephone Number	:	317-842-7928
Fax Number	:	317-841-3337

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	BEN H PARK
Credential	:	MD
Telephone Number	:	317-580-6307

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	06/22/2017

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