Provider Demographics
NPI:1699085605
Name:CAROLINAS PHYSICIANS NETWORK INC
Entity type:Organization
Organization Name:CAROLINAS 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:
Authorized Official - Last Name:WIENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-355-0648
Mailing Address - Street 1:PO BOX 602148
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2148
Mailing Address - Country:US
Mailing Address - Phone:704-302-8375
Mailing Address - Fax:704-302-8548
Practice Address - Street 1:332 SAM NEWELL RD
Practice Address - Street 2:SUITE 2000
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-6566
Practice Address - Country:US
Practice Address - Phone:704-302-8375
Practice Address - Fax:704-302-8548
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAS PHYSICIANS NETWORK INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-13
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2381152CMedicare PIN