# AMERICAN HEALTH NETWORK OF INDIANA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** AMERICAN HEALTH NETWORK OF INDIANA, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1639273014
- **Legal business name:** AMERICAN HEALTH NETWORK OF INDIANA, LLC
- **Authorized official:** BEN H PARK MD (PRESIDENT AND CEO)
- **Authorized official phone:** (317) 580-6307

## Contact information

- **Practice address:** 101 S. LIBERTY STREET, RUSSIAVILLE, IN 46979
- **Practice address phone:** (765) 883-2273
- **Practice address fax:** (765) 883-5168
- **Mailing address:** PO BOX 400, RUSSIAVILLE, IN 46979-0400
- **Mailing address phone:** (765) 883-2273
- **Mailing address fax:** (765) 883-5168

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 2085N0904X | Nuclear Radiology Physician | — | NULL | — |
| 2085N0904X | Nuclear Radiology Physician | — | — | — |
| 2085R0202X | Diagnostic Radiology Physician | — | NULL | — |
| 2085R0202X | Diagnostic Radiology Physician | — | — | — |
| 2085U0001X | Diagnostic Ultrasound Physician | — | NULL | — |
| 2085U0001X | Diagnostic Ultrasound Physician | — | — | — |

## Other

- **Enumeration date:** 09/07/2006
- **Last updated:** 01/09/2008