Provider Demographics
NPI:1669019956
Name:MCPC-8, LLC
Entity Type:Organization
Organization Name:MCPC-8, LLC
Other - Org Name:FIRSTHEALTH CONVENIENT CARE - LAKE TILLERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEJACO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-715-4473
Mailing Address - Street 1:8004 HIGHWAY 73 W
Mailing Address - Street 2:
Mailing Address - City:MT. GILEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8004 HIGHWAY 73 W
Practice Address - Street 2:
Practice Address - City:MT. GILEAD
Practice Address - State:NC
Practice Address - Zip Code:27306
Practice Address - Country:US
Practice Address - Phone:336-523-0040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-05
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty