Provider Demographics
NPI:1699034355
Name:MCPC-1, LLC
Entity Type:Organization
Organization Name:MCPC-1, LLC
Other - Org Name:FIRSTHEALTH RICHMOND MEDICAL GROUP WOMEN'S CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:SEALS
Authorized Official - Last Name:DEJACO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-715-1913
Mailing Address - Street 1:212 S RUTHERFORD ST
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-2652
Mailing Address - Country:US
Mailing Address - Phone:704-694-2692
Mailing Address - Fax:704-695-1759
Practice Address - Street 1:212 S RUTHERFORD ST
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-2652
Practice Address - Country:US
Practice Address - Phone:704-694-2692
Practice Address - Fax:704-695-1759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty