Provider Demographics
NPI:1962578682
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: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:P O BOX 601888
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0628
Mailing Address - Country:US
Mailing Address - Phone:704-289-5443
Mailing Address - Fax:704-283-7655
Practice Address - Street 1:1106 REYNOLDS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4350
Practice Address - Country:US
Practice Address - Phone:704-289-5443
Practice Address - Fax:704-283-7655
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNION PHYSICIANS NETWORK INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-27
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
NC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905686Medicaid
NC7705117Medicaid
NC018P6OtherBCBS
SCNPB206Medicaid
NC5905686Medicaid
NC5701240004Medicare NSC