Indian Trail Family Medicine

LBN: Indian Trail Family Medicine
Indian Trail Family Medicine is an health care organization with primary practice located at 4503 Old Monroe Rd , Indian Trail NC 28079-5309. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as the primary health care specialty. Indian Trail Family Medicine can be contacted via phone (704) 821-6900, or through Wiens, Daniel L via phone (704) 355-0648.

Contact Information

Primary practice address
4503 Old Monroe Rd Indian Trail NC 28079-5309
Phone: (704) 821-6900
Fax: (704) 821-6911
Website:
Map and Directions
Authorized official contact:
Name: Wiens, Daniel L
Phone: (704) 355-0648

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X

Profile Details

NPI number 1003842782
LBN Legal business name Indian Trail Family Medicine
DBA Doing business as
Authorized official Wiens, Daniel L
Entity Organization
Organization subpart 1 No
Enumeration date Jun 24th, 2006
Last updated Feb 12th, 2008 - about 17 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003842782 NPPES
North Carolina MEDICAID 7901052

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