Provider Demographics
NPI:1255698650
Name:MCPC-1, LLC
Entity type:Organization
Organization Name:MCPC-1, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:522 ALLEN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TROY
Mailing Address - State:NC
Mailing Address - Zip Code:27371-2861
Mailing Address - Country:US
Mailing Address - Phone:910-571-5710
Mailing Address - Fax:910-576-3367
Practice Address - Street 1:522 ALLEN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:TROY
Practice Address - State:NC
Practice Address - Zip Code:27371-2861
Practice Address - Country:US
Practice Address - Phone:910-571-5710
Practice Address - Fax:910-576-3367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty