NPIMap

Organization Active NPI

Union Physicians Network Inc

Doing business as Indian Trail Family Medicine

  • Family Medicine Physician
  • Indian Trail, NC
National Provider Identifier
1043386766
Registry record updated Aug 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
UNION PHYSICIANS NETWORK INC
Doing business as
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
Nov 27, 2006
Organization subpart
Yes
Parent organization
UNION PHYSICIANS NETWORK INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 19, 2011

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

Authorized official

Name
Mr. Daniel L Wiens
Title
Senior Vice President
Phone
(704) 355-0648

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

4503 Old Monroe Rd
Indian Trail, NC 28079-5309

Mailing address

P O Box 601895
Charlotte, NC 28260-0628
Phone (704) 821-6900

Other identifiers 2

IdentifierTypeStateIssuer
NPB207MedicaidSC
5905819MedicaidNC

Other names 1

  • Indian Trail Family Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Union Physicians Network Inc24 organizations share this tax ID, including this one
Part of
Union Physicians Network Inc

Other organizations with this tax ID 23

Organizations that report the same tax identification number in the National Provider Directory.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313712000000",
    "number": "1043386766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O BOX 601895",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600628",
            "telephone_number": "704-821-6900",
            "fax_number": "704-821-6911"
        },
        {
            "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": "UNION PHYSICIANS NETWORK INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UNION PHYSICIANS NETWORK INC",
        "enumeration_date": "2006-11-27",
        "last_updated": "2011-08-19",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "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": "NPB207",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5905819",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indian Trail Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indian Trail, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2011; 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.