Provider Demographics
NPI:1902895162
Name:CAROLINAS PHYSICIANS NETWORK INC.
Entity Type:Organization
Organization Name:CAROLINAS PHYSICIANS NETWORK INC.
Other - Org Name:CABARRUS FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MR
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 602120
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2120
Mailing Address - Country:US
Mailing Address - Phone:704-721-7430
Mailing Address - Fax:704-721-7431
Practice Address - Street 1:270 COPPERFIELD BLVD NE
Practice Address - Street 2:SUITE 10
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2441
Practice Address - Country:US
Practice Address - Phone:704-721-7430
Practice Address - Fax:704-721-7431
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAS PHYSICIANS NETWORK INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-19
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006202Medicaid
NC6006202Medicaid