Provider Demographics
NPI:1992714299
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:
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 60544
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0544
Mailing Address - Country:US
Mailing Address - Phone:704-289-3024
Mailing Address - Fax:704-226-1236
Practice Address - Street 1:1550 FAULK STREET
Practice Address - Street 2:SUITE 1100
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5087
Practice Address - Country:US
Practice Address - Phone:704-289-3024
Practice Address - Fax:704-226-1236
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNION PHYSICIANS NETWORK INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-05
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNPB143OtherBLUE CROSS BLUE SHIELD
NC2332468BMedicare ID - Type UnspecifiedGROUP MEDICARE #
NCNPB143OtherBLUE CROSS BLUE SHIELD