NPIMap

Organization Active NPI

Shiland Family Medicine

  • Family Medicine Physician
  • Charlotte, NC
National Provider Identifier
1124357124
Registry record updated Mar 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SHILAND FAMILY MEDICINE
Practice address
13640 Steelecroft Pkwy
Suite 320
Charlotte, NC 28278-7565
Phone
(803) 329-5131
Fax
(803) 366-6600
NPI assigned
Dec 22, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2010

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 of Operations
Phone
(704) 355-0648

Specialties & licenses 1

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

Addresses

Primary practice location

13640 Steelecroft Pkwy
Suite 320
Charlotte, NC 28278-7565

Mailing address

PO Box 60114
Charlotte, NC 28260-0114
Phone (803) 329-5131

Other identifiers 1

IdentifierTypeStateIssuer
NPB357MedicaidSC

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1261440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269475200000",
    "number": "1124357124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60114",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600114",
            "telephone_number": "803-329-5131",
            "fax_number": "803-366-6600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13640 STEELECROFT PKWY",
            "address_2": "SUITE 320",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282787565",
            "telephone_number": "803-329-5131",
            "fax_number": "803-366-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHILAND FAMILY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-22",
        "last_updated": "2010-03-25",
        "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 OF OPERATIONS",
        "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": "NPB357",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2010; 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.