Provider Demographics
NPI:1659380079
Name:UNION URGENT CARE LLC
Entity Type:Organization
Organization Name:UNION URGENT CARE LLC
Other - Org Name:CAROLINAS HEALTHCARE URGENT CARE - UNION WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WIENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-355-0648
Mailing Address - Street 1:PO BOX 60735
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0735
Mailing Address - Country:US
Mailing Address - Phone:704-246-2777
Mailing Address - Fax:704-246-4788
Practice Address - Street 1:6030 W HIGHWAY 74
Practice Address - Street 2:SUITE A
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-3468
Practice Address - Country:US
Practice Address - Phone:704-246-2777
Practice Address - Fax:704-246-4788
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNION URGENT CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-05
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY017G2OtherBLUE CROSS - BLUE SHIELD
NC5901877Medicaid
NC5901877Medicaid
NC5467070002Medicare NSC