MEDICARE: UNC PHYSICIANS NETWORK LLC

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	332900000X	Non-Pharmacy Dispensing Site	2011-01111	NC

General Provider Information

NPI Number	:	1891062212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNC PHYSICIANS NETWORK LLC

Provider Business Mailing Address
First Line	:	9276 SCRANTON RD
Second Line	:	SUITE 100
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-7701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6101 QUADRANGLE DR
Second Line	:	100
City	:	CHAPEL HILL
State	:	NC
Zip	:	27517-8655
Country	:	US
Telephone Number	:	919-445-6000
Fax Number	:

Authorized Official
Title or Position	:	VP OF OPERATIONS
Name	:	KENNY HEINE
Credential	:
Telephone Number	:	858-625-2990

Provider Enumeration Date	:	11/30/2011
Last Update Date	:	04/07/2016

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