Healthcare Provider Details

I. General information

NPI: 1487919973
Provider Name (Legal Business Name): MCPC-9, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 S LONG DR STE K
ROCKINGHAM NC
28379-4375
US

IV. Provider business mailing address

809 S LONG DR STE K
ROCKINGHAM NC
28379-4375
US

V. Phone/Fax

Practice location:
  • Phone: 910-417-4096
  • Fax: 910-417-4099
Mailing address:
  • Phone: 910-417-4096
  • Fax: 910-417-4099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

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