# CAROLINAS PHYSICIANS NETWORK INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CAROLINAS PHYSICIANS NETWORK INC
- **Other names:** Cabarrus Family Medicine - Mallard Creek
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1033340922
- **Legal business name:** CAROLINAS PHYSICIANS NETWORK INC
- **Authorized official:** DANIEL L WIENS (SENIOR VICE PRESIDENT - OPERATIONS)
- **Authorized official phone:** (704) 355-0648

## Contact information

- **Practice address:** 10320 MALLARD CREEK ROAD, SUITE 100, CHARLOTTE, NC 28262-5204
- **Practice address phone:** (704) 863-4000
- **Practice address fax:** (704) 547-9515
- **Mailing address:** PO BOX 602120, CHARLOTTE, NC 28260-2120
- **Mailing address phone:** (704) 863-4000
- **Mailing address fax:** (704) 547-9515

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 07/27/2009
- **Last updated:** 06/06/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 5950053 | — | NC |
| 01 | — | 7705276 | NC MEDICAID DME | NC |