Healthcare Provider Details

I. General information

NPI: 1679119499
Provider Name (Legal Business Name): MCPC-5, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2019
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 PAGE RD N
PINEHURST NC
28374-4607
US

IV. Provider business mailing address

120 PAGE RD N
PINEHURST NC
28374-4607
US

V. Phone/Fax

Practice location:
  • Phone: 910-715-8691
  • Fax: 910-235-7884
Mailing address:
  • Phone: 910-715-8691
  • Fax: 910-235-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

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