Provider Demographics
NPI:1871817403
Name:CAROLINAS PHYSICIANS NETWORK INC
Entity Type:Organization
Organization Name:CAROLINAS PHYSICIANS NETWORK INC
Other - Org Name:THE SANGER CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT OPERATIONS
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 60122
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0122
Mailing Address - Country:US
Mailing Address - Phone:336-846-8334
Mailing Address - Fax:336-846-8339
Practice Address - Street 1:200 HOSPITAL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640-9244
Practice Address - Country:US
Practice Address - Phone:336-846-8334
Practice Address - Fax:336-846-8339
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAS PHYSICIANS NETWORK INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-25
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQPB744Medicaid
NC5903111Medicaid
SCQPB744Medicaid