Provider Demographics
NPI:1376841874
Name:UNC PHYSICIANS NETWORK, LLC
Entity Type:Organization
Organization Name:UNC PHYSICIANS NETWORK, LLC
Other - Org Name:REX FAMILY PRACTICE OF WAKEFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:FISCUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:984-215-4111
Mailing Address - Street 1:2000 PERIMETER PARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11200 GOVERNOR MANLY WAY STE 205
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-7367
Practice Address - Country:US
Practice Address - Phone:919-570-7700
Practice Address - Fax:919-570-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1376841874Medicaid
NC1376841874Medicaid