Healthcare Provider Details

I. General information

NPI: 1154354447
Provider Name (Legal Business Name): UNION PHYSICIANS NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 FAULK STREET SUITE 2100
MONROE NC
28112-5087
US

IV. Provider business mailing address

PO BOX 60154
CHARLOTTE NC
28260-0154
US

V. Phone/Fax

Practice location:
  • Phone: 704-289-2553
  • Fax: 704-289-6496
Mailing address:
  • Phone: 704-289-2553
  • Fax: 704-289-6496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

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