Indian Trail Family Medicine

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

INDIAN TRAIL FAMILY MEDICINE

Practice address

4503 Old Monroe Rd
Indian Trail, NC 28079-5309

Phone

(704) 821-6900

Fax

(704) 821-6911

NPI assigned

Jun 24, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Daniel L Wiens

Title

Senior Vice President

Phone

(704) 355-0648

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joseph Gregory McCabe, D.O.

  • Family Medicine Physician
  • Morehead City, NC
  • NPI 1174542500
  NPD (past)
• Adona Christine Struve I

  • Physician Assistant
  • Monroe, NC
  • NPI 1689688384
  NPD (past)
• Wilma Lynne Wachowiak, APRN, BC

  • Family Nurse Practitioner
  • Monroe, NC
  • NPI 1982620423
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202774400000",
    "number": "1003842782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 AIRPORT CENTER PKWY STE A",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282085899",
            "telephone_number": "704-512-4116",
            "fax_number": "704-371-7284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4503 OLD MONROE RD",
            "city": "INDIAN TRAIL",
            "state": "NC",
            "postal_code": "280795309",
            "telephone_number": "704-821-6900",
            "fax_number": "704-821-6911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN TRAIL FAMILY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "last_updated": "2008-02-12",
        "status": "A",
        "authorized_official_last_name": "WIENS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "704-355-0648"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7901052",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Idlewild Family Dentistry, LLC
• Onyinye Igbokwe, MD
• Imbue Health PLLC
• Indian Trail Chiropractic & Rehabilitation, P.a.
• Indian Trail Chiropractic & Rehabilitation, PA
• Indian Trail Medical Clinic, Inc.
• Indian Trail Pharmacy, Inc.
• Indian Trail Specific Chiropractic Inc
• Infinity Dental Arts
• Innercity Transportation LLC

• Family Medicine Physician in Indian Trail, NC
• Providers in Indian Trail, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.