Healthcare Provider Details

I. General information

NPI: 1659380079
Provider Name (Legal Business Name): UNION URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6030 W HIGHWAY 74 SUITE A
INDIAN TRAIL NC
28079-3468
US

IV. Provider business mailing address

PO BOX 60735
CHARLOTTE NC
28260-0735
US

V. Phone/Fax

Practice location:
  • Phone: 704-246-2777
  • Fax: 704-246-4788
Mailing address:
  • Phone: 704-246-2777
  • Fax: 704-246-4788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DANIEL L WIENS
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 704-355-0648