Provider Demographics
NPI:1457604902
Name:MCPC-5, LLC
Entity type:Organization
Organization Name:MCPC-5, 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 1:6322 FAYETTEVILLE RD STE B
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-7979
Mailing Address - Country:US
Mailing Address - Phone:910-878-6700
Mailing Address - Fax:910-235-7924
Practice Address - Street 1:6322 FAYETTEVILLE RD STE B
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-7979
Practice Address - Country:US
Practice Address - Phone:910-878-6700
Practice Address - Fax:910-235-7924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty