NPIMap

Organization Active NPI

Union Family Practice

  • Family Medicine Physician
  • Monroe, NC
National Provider Identifier
1073540365
Registry record updated May 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
UNION FAMILY PRACTICE
Practice address
1106 Reynolds Street
Suite 100
Monroe, NC 28112-4376
Phone
(704) 289-5443
Fax
(704) 283-7655
NPI assigned
Jun 26, 2006
Last updated
May 17, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2013

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

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

1106 Reynolds Street
Suite 100
Monroe, NC 28112-4376

Mailing address

PO Box 601888
Charlotte, NC 28260-1888
Phone (704) 289-5443

Other identifiers 2

IdentifierTypeStateIssuer
NPB206MedicaidSC
5905686MedicaidNC

National Provider Directory

National Provider Directory

Locations

1106 Reynolds St
Monroe, NC 28112
Phone (704) 226-5013

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368748800000",
    "number": "1073540365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601888",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601888",
            "telephone_number": "704-289-5443",
            "fax_number": "704-283-7655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 REYNOLDS STREET",
            "address_2": "SUITE 100",
            "city": "MONROE",
            "state": "NC",
            "postal_code": "281124376",
            "telephone_number": "704-289-5443",
            "fax_number": "704-283-7655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNION FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-26",
        "last_updated": "2013-05-17",
        "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": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NPB206",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5905686",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2013; 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.