Healthcare Provider Details

I. General information

NPI: 1366353427
Provider Name (Legal Business Name): MCPC-12, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 BEECHTREE DR STE 2300
SANFORD NC
27330-6934
US

IV. Provider business mailing address

2919 BEECHTREE DR STE 2300
SANFORD NC
27330-6934
US

V. Phone/Fax

Practice location:
  • Phone: 910-692-7928
  • Fax:
Mailing address:
  • Phone: 910-692-7928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

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