Provider Demographics
NPI:1154354447
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 60154
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0154
Mailing Address - Country:US
Mailing Address - Phone:704-289-2553
Mailing Address - Fax:704-289-6496
Practice Address - Street 1:1550 FAULK STREET
Practice Address - Street 2:SUITE 2100
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5087
Practice Address - Country:US
Practice Address - Phone:704-289-2553
Practice Address - Fax:704-289-6496
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNION PHYSICIANS NETWORK INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-09
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNPB170Medicaid
NC017Y2OtherBCBS
NC5902878Medicaid
SCNPB171Medicaid
NC5902877Medicaid
SCNPB171Medicaid