Healthcare Provider Details

I. General information

NPI: 1669019956
Provider Name (Legal Business Name): MCPC-8, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8004 HIGHWAY 73 W
MT. GILEAD NC
27306
US

IV. Provider business mailing address

8004 HIGHWAY 73 W
MT. GILEAD NC
27306
US

V. Phone/Fax

Practice location:
  • Phone: 336-523-0040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICKEY FOSTER
Title or Position: CEO
Credential:
Phone: 910-715-4473