Healthcare Provider Details

I. General information

NPI: 1669602504
Provider Name (Legal Business Name): CAROLINAS PHYSICIANS NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2009
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 HIGHWAY 49 N
RICHFIELD NC
28137-5738
US

IV. Provider business mailing address

PO BOX 602120
CHARLOTTE NC
28260-2120
US

V. Phone/Fax

Practice location:
  • Phone: 704-463-6521
  • Fax: 704-463-0400
Mailing address:
  • Phone: 704-463-6521
  • Fax: 704-463-0400

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 - OPERATIONS
Credential:
Phone: 704-355-0648