1144477837 NPI number — UNION PHYSICIANS NETWORK INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144477837 NPI number — UNION PHYSICIANS NETWORK INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNION PHYSICIANS NETWORK INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144477837
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 602107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28260-2107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-226-0413
Provider Business Mailing Address Fax Number:
704-296-5646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1428 ELLEN STREET
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28112-5286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-226-0413
Provider Business Practice Location Address Fax Number:
704-296-5646
Provider Enumeration Date:
08/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WIENS
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
SENIOR VICE PRESIDENT OF OPERATIONS
Authorized Official Telephone Number:
704-355-0648

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NPB278 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5950356 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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