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Organization
UNION PHYSICIANS NETWORK INC
Active
Organization
UNION PHYSICIANS NETWORK INC
Active
Parent organization
UNION PHYSICIANS NETWORK INC
Other names
Lake Park Family Practice
Organization subpart
Yes
Provider details
NPI number
Legal business name
UNION PHYSICIANS NETWORK INC
Authorized official
DANIEL L WIENS (SENIOR VICE PRESIDENT)
(704) 355-0648
Entity
Organization
Contact information
Practice address
6208 CREFT CIR, SUITE 222, INDIAN TRAIL, NC 28079-9003
(704) 882-1666
(704) 882-2789
Mailing address
PO BOX 60643, CHARLOTTE, NC 28260-0643
(704) 882-1666
(704) 882-2789
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014PK
BLUE CROSS - BLUE SHIELD
NC
01
—
7705363
NC MEDICAID DME SUPPLIER
NC
05
—
89014PK
—
NC
Enumeration date
08/05/2006
Last updated
06/28/2012
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