Healthcare Provider Details

I. General information

NPI: 1184947566
Provider Name (Legal Business Name): CAROLINAS PHYSICIANS NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

2450 INDIA HOOK RD
ROCK HILL SC
29732-3270
US

IV. Provider business mailing address

PO BOX 602115
CHARLOTTE NC
28260-2115
US

V. Phone/Fax

Practice location:
  • Phone: 704-381-3510
  • Fax: 704-540-3668
Mailing address:
  • Phone: 704-381-3510
  • Fax: 704-540-3668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number
License Number State

VIII. Authorized Official

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