Healthcare Provider Details

I. General information

NPI: 1851616353
Provider Name (Legal Business Name): CAROLINAS PHYSICIANS NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 06/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3431 MORGANTON BLVD SW
LENOIR NC
28645-8628
US

IV. Provider business mailing address

PO BOX 601067
CHARLOTTE NC
28260-1067
US

V. Phone/Fax

Practice location:
  • Phone: 704-373-0212
  • Fax: 704-342-5871
Mailing address:
  • Phone: 704-373-0212
  • Fax: 704-342-5871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL L WIENS
Title or Position: SVP
Credential:
Phone: 704-355-0648