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4105 Matthews Mint Hill Rd Matthews NC 28105-3633 | |
| (704) 545-4609 | |
| (704) 545-4798 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 4105 Matthews Mint Hill Rd, Matthews, North Carolina |
| Authorized Official Name and Position | Daniel L. Wiens (SENIOR VICE PRESIDENT OF OPERATIONS) |
| Authorized Official Contact | 7043550648 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 601949 Charlotte NC 28260-1949 Ph: (704) 545-4609 | 4105 Matthews Mint Hill Rd Matthews NC 28105-3633 Ph: (704) 545-4609 |
| NPI Number | 1215125919 |
|---|---|
| Provider Enumeration Date | 10/09/2007 |
| Last Update Date | 12/22/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215125919 | NPI | - | NPPES |
| 5908365 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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