Healthcare Provider Details

I. General information

NPI: 1134412117
Provider Name (Legal Business Name): UNION PHYSICIANS NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 WEDDINGTON RD
WESLEY CHAPEL NC
28104-6273
US

IV. Provider business mailing address

PO BOX 602583
CHARLOTTE NC
28260-2583
US

V. Phone/Fax

Practice location:
  • Phone: 704-667-4280
  • Fax: 704-667-4281
Mailing address:
  • Phone: 704-515-4808
  • Fax: 704-512-4838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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