Healthcare Provider Details

I. General information

NPI: 1811210917
Provider Name (Legal Business Name): UNION PHYSICIANS NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423-B E FRANKLIN STREET
MONROE NC
28112-5087
US

IV. Provider business mailing address

PO BOX 602416
CHARLOTTE NC
28260-2416
US

V. Phone/Fax

Practice location:
  • Phone: 704-290-5020
  • Fax: 704-290-5029
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

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