Provider Demographics
NPI:1518312073
Name:MCPC-17, LLC
Entity Type:Organization
Organization Name:MCPC-17, LLC
Other - Org Name:FIRSTHEALTH INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICKEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-715-4473
Mailing Address - Street 1:PO BOX 18384
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4078
Mailing Address - Country:US
Mailing Address - Phone:910-255-0033
Mailing Address - Fax:910-255-0036
Practice Address - Street 1:293 OLMSTED BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9181
Practice Address - Country:US
Practice Address - Phone:910-255-0033
Practice Address - Fax:910-255-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty