NPIMap

Organization Active NPI

Mecklenburg Medical Group

  • Internal Medicine Physician
  • Huntersville, NC
National Provider Identifier
1669797536
Registry record updated Apr 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MECKLENBURG MEDICAL GROUP
Practice address
16455 Statesville Road
Suite 200
Huntersville, NC 28078-7125
Phone
(704) 367-6610
Fax
(704) 367-6650
NPI assigned
Apr 2, 2010
Last updated
Apr 2, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 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
Phone
(704) 355-0648

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

16455 Statesville Road
Suite 200
Huntersville, NC 28078-7125

Mailing address

PO Box 60063
Charlotte, NC 28260-0063
Phone (704) 367-6610

National Provider Directory

National Provider Directory
Tax ID family
Mecklenburg Medical Group9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

NPI Registry JSON

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

{
    "created_epoch": "1270166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270166400000",
    "number": "1669797536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60063",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600063",
            "telephone_number": "704-367-6610",
            "fax_number": "704-367-6650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16455 STATESVILLE ROAD",
            "address_2": "SUITE 200",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280787125",
            "telephone_number": "704-367-6610",
            "fax_number": "704-367-6650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MECKLENBURG MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-02",
        "last_updated": "2010-04-02",
        "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": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntersville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 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.