Provider Demographics
NPI:1922017391
Name:UNION PHYSICIANS NETWORK INC
Entity type:Organization
Organization Name:UNION PHYSICIANS NETWORK INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WIENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-355-0648
Mailing Address - Street 1:PO BOX 601215
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1215
Mailing Address - Country:US
Mailing Address - Phone:704-243-2254
Mailing Address - Fax:704-243-2339
Practice Address - Street 1:2700 PROVIDENCE ROAD SOUTH
Practice Address - Street 2:SUITE 300
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173
Practice Address - Country:US
Practice Address - Phone:704-243-2254
Practice Address - Fax:704-243-2339
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNION PHYSICIANS NETWORK INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-05
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89012UNMedicaid
NC012UNOtherBLUE CROSS - BLUE SHIELD
NC012UNOtherBLUE CROSS - BLUE SHIELD