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6030 W Highway 74 Suite A Indian Trail NC 28079-3468 | |
(704) 246-2777 | |
(704) 246-4788 |
Full Name | |
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Speciality | Family Medicine |
Location | 6030 W Highway 74, Indian Trail, North Carolina |
Authorized Official Name and Position | Daniel L Wiens (SENIOR VICE PRESIDENT) |
Authorized Official Contact | 7043550648 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 60735 Charlotte NC 28260-0735 Ph: (704) 246-2777 | 6030 W Highway 74 Suite A Indian Trail NC 28079-3468 Ph: (704) 246-2777 |
NPI Number | 1659380079 |
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Provider Enumeration Date | 08/05/2006 |
Last Update Date | 02/12/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1659380079 | NPI | - | NPPES |
017G2 | Other | NY | BLUE CROSS - BLUE SHIELD |
5901877 | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
Indian Trail Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4503 Old Monroe Rd, Indian Trail, NC 28079 Phone: 704-821-6900 Fax: 704-821-6911 | |
Imbue Health Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4389 Indian Trail Fairview Rd Ste 7, Indian Trail, NC 28079 Phone: 704-218-9322 Fax: 704-803-8126 | |