INDIAN TRAIL FAMILY MEDICINE
NPI 1003842782
Family Medicine in Indian Trail, NC

Q: What is Indian Trail Family Medicine's NPI number?

The NPI number for Indian Trail Family Medicine is 1003842782. It was assigned to this organization in the NPPES registry on June 24, 2006.

Q: What is Indian Trail Family Medicine's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Active since June 24, 2006

4503 OLD MONROE RD, INDIAN TRAIL, NC 28079(704) 821-6900(704) 821-6911 Get Directions Write a Review

NPPES record last updated: February 12, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Indian Trail Family Medicine NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

INDIAN TRAIL FAMILY MEDICINE (NPI 1003842782) is a healthcare organization registered as a family medicine in Indian Trail, North Carolina and active in the NPI registry since June 2006. The organization lists Daniel L Wiens, Senior Vice President, as its authorized official.

NPPES Registry Identity

NPI1003842782

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameINDIAN TRAIL FAMILY MEDICINE

Location Address4503 OLD MONROE RDIndian Trail, NC 28079-5309

Mailing Address5000 Airport Center Pkwy Ste ACharlotte, NC 28208-5899 · (704) 512-4116 · Fax (704) 371-7284

Phone(704) 821-6900

Fax(704) 821-6911

Organization SubpartNo

Authorized OfficialDaniel L WiensSenior Vice President · (704) 355-0648

Enumeration DateJune 24, 2006

Last NPPES UpdateFebruary 12, 2008

✔ NPI 1003842782 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

4503 OLD MONROE RD, Indian Trail, NC 28079

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Other Identifiers 3

Medicare ID-Type Unspecified2344519NC · Group Number

Medicare NSC5320700001NC

Medicaid7901052NC

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LISBETH DAVILA MIJANGOS NP

Nurse Practitioner (Family)