Provider Demographics
NPI:1922307008
Name:UNION PHYSICIANS NETWORK INC
Entity Type:Organization
Organization Name:UNION PHYSICIANS NETWORK INC
Other - Org Name:UPN SHVI - MONROE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
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:704-335-0648
Mailing Address - Street 1:PO BOX 602545
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2545
Mailing Address - Country:US
Mailing Address - Phone:704-667-3410
Mailing Address - Fax:704-667-3479
Practice Address - Street 1:1550 FAULK STREET
Practice Address - Street 2:SUITE 3100
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5197
Practice Address - Country:US
Practice Address - Phone:704-667-3410
Practice Address - Fax:704-667-3479
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNION PHYSICIANS NETWORK, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-15
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5917589Medicaid
SCNPB460Medicaid
NC2332468PMedicare PIN