Provider Demographics
NPI:1144477837
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 OF OPERATIONS
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 602107
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2107
Mailing Address - Country:US
Mailing Address - Phone:704-226-0413
Mailing Address - Fax:704-296-5646
Practice Address - Street 1:1428 ELLEN STREET
Practice Address - Street 2:SUITE B
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5286
Practice Address - Country:US
Practice Address - Phone:704-226-0413
Practice Address - Fax:704-296-5646
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNION PHYSICIANS NETWORK INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-25
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNPB278Medicaid
NC5950356Medicaid
NC5950356Medicaid