Healthcare Provider Details

I. General information

NPI: 1114351095
Provider Name (Legal Business Name): MCPC-16, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6322 FAYETTEVILLE RD
RAEFORD NC
28376-7979
US

IV. Provider business mailing address

6322 FAYETTEVILLE RD
RAEFORD NC
28376-7979
US

V. Phone/Fax

Practice location:
  • Phone: 910-878-6700
  • Fax: 910-878-6705
Mailing address:
  • Phone: 910-878-6700
  • Fax: 910-878-6705

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
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

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