Provider Demographics
NPI:1730279787
Name:CAROLINAS PHYSICIANS NETWORK INC.
Entity Type:Organization
Organization Name:CAROLINAS PHYSICIANS NETWORK INC.
Other - Org Name:CHARLOTTE CARDIOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MR
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 60309
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0309
Mailing Address - Country:US
Mailing Address - Phone:704-944-1135
Mailing Address - Fax:704-944-1155
Practice Address - Street 1:309 S SHARON AMITY RD
Practice Address - Street 2:STE. 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2978
Practice Address - Country:US
Practice Address - Phone:704-944-1135
Practice Address - Fax:704-944-1155
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAS PHYSICIANS NETWORK INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-13
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC019K0OtherBCBS
NC5907960Medicaid
NC5907962Medicaid
SCQPB818Medicaid
NC5907963Medicaid
SCNPB247Medicaid
SCGP4737Medicaid
SCNPB245Medicaid
NC5907958Medicaid
NC5907961Medicaid
NC5907964Medicaid
SCNPB246Medicaid
NC5907959Medicaid
SCNPB248Medicaid
SCQPB819Medicaid
NC5907960Medicaid
NC5907961Medicaid