Healthcare Provider Details

I. General information

NPI: 1932921137
Provider Name (Legal Business Name): MCPC-14, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 PAGE RD N STE 310
PINEHURST NC
28374-4607
US

IV. Provider business mailing address

135 PAGE RD N STE 310
PINEHURST NC
28374-4607
US

V. Phone/Fax

Practice location:
  • Phone: 910-715-0998
  • Fax: 910-235-7998
Mailing address:
  • Phone: 910-715-0998
  • Fax: 910-235-7998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

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