# UNION PHYSICIANS NETWORK INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** UNION PHYSICIANS NETWORK INC
- **Other names:** Lake Park Family Practice
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1578572939
- **Legal business name:** UNION PHYSICIANS NETWORK INC
- **Authorized official:** DANIEL L WIENS (SENIOR VICE PRESIDENT)
- **Authorized official phone:** (704) 355-0648

## Contact information

- **Practice address:** 6208 CREFT CIR, SUITE 222, INDIAN TRAIL, NC 28079-9003
- **Practice address phone:** (704) 882-1666
- **Practice address fax:** (704) 882-2789
- **Mailing address:** PO BOX 60643, CHARLOTTE, NC 28260-0643
- **Mailing address phone:** (704) 882-1666
- **Mailing address fax:** (704) 882-2789

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/05/2006
- **Last updated:** 06/28/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 014PK | BLUE CROSS - BLUE SHIELD | NC |
| 01 | — | 7705363 | NC MEDICAID DME SUPPLIER | NC |
| 05 | — | 89014PK | — | NC |