Organization
CAROLINAS PHYSICIANS NETWORK INC
Active
Other names
Indian Trail Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL L WIENS (SENIOR VICE PRESIDENT)
(704) 355-0648
Entity
Organization
Contact information
Practice address
6030 W HIGHWAY 74, SUITE F, INDIAN TRAIL, NC 28079-3468
(704) 246-2900
(704) 246-2899
Mailing address
PO BOX 60026, CHARLOTTE, NC 28260-0026
(704) 246-2900
(704) 246-2899
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017GY
BLUE CROSS - BLUE SHIELD
NC
05
—
5901967
—
NC
05
—
NPB120
—
SC
Enumeration date
08/05/2006
Last updated
08/22/2020
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