Provider Demographics
NPI:1932486289
Name:MCPC-4 LLC
Entity Type:Organization
Organization Name:MCPC-4 LLC
Other - Org Name:FIRSTHEALTH RICHMOND MEDICAL GROUP-GENERAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP - 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:910-715-1913
Mailing Address - Street 1:921 S LONG DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-4874
Mailing Address - Country:US
Mailing Address - Phone:910-417-3540
Mailing Address - Fax:910-417-4369
Practice Address - Street 1:921 S LONG DR
Practice Address - Street 2:SUITE 208
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-4874
Practice Address - Country:US
Practice Address - Phone:910-417-3540
Practice Address - Fax:910-417-4369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty