Provider Demographics
NPI:1275965410
Name:MCPC-14, LLC
Entity Type:Organization
Organization Name:MCPC-14, LLC
Other - Org Name:FIRSTHEALTH TRANSITION CARE CLINIC
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:910-715-1913
Mailing Address - Street 1:PO BOX 896208
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-6208
Mailing Address - Country:US
Mailing Address - Phone:910-715-8355
Mailing Address - Fax:910-715-8370
Practice Address - Street 1:305 PAGE RD N STE 1
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-0086
Practice Address - Country:US
Practice Address - Phone:910-715-8355
Practice Address - Fax:910-715-8370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-30
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty