Organization
CAROLINAS PHYSICIANS NETWORK INC
Active
Parent organization
CAROLINAS PHYSICIANS NETWORK INC
Other names
Cabarrus Family Medicine - Mallard Creek
Organization subpart
Yes
Provider details
NPI number
Legal business name
CAROLINAS PHYSICIANS NETWORK INC
Authorized official
DANIEL L WIENS (SENIOR VICE PRESIDENT - OPERATIONS)
(704) 355-0648
Entity
Organization
Contact information
Practice address
10320 MALLARD CREEK ROAD, SUITE 100, CHARLOTTE, NC 28262-5204
(704) 863-4000
(704) 547-9515
Mailing address
PO BOX 602120, CHARLOTTE, NC 28260-2120
(704) 863-4000
(704) 547-9515
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5950053
—
NC
01
—
7705276
NC MEDICAID DME
NC
Enumeration date
07/27/2009
Last updated
06/06/2013
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