MEDICARE: UNION PHYSICIANS NETWORK INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770659492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNION PHYSICIANS NETWORK INC

Provider Business Mailing Address
First Line	:	PO BOX 601885
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0628
Country	:	US
Telephone Number	:	704-226-6474
Fax Number	:	704-289-2355

Provider Business Practice Location Address
First Line	:	1423 E FRANKLIN ST
Second Line	:	SUITE D
City	:	MONROE
State	:	NC
Zip	:	28112-5266
Country	:	US
Telephone Number	:	704-226-6474
Fax Number	:	704-289-2355

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT
Name	:	MR. DANIEL L WIENS
Credential	:
Telephone Number	:	704-355-0648

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	08/19/2011

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