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General NPI Number Information
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NPI Number | 1093065229
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Entity Type | Organization
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Legal Business Name | MCPC-6, LLC
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 4565 FAYETTEVILLE RD SUITE B
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City | RAEFORD
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State | NC
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Zip | 28376-7998
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Country | US
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Telephone | 910-878-5150
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Fax | 910-878-5190
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Provider Business Mailing Address
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Address Line | 4565 FAYETTEVILLE RD SUITE B
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City | RAEFORD
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State | NC
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Zip | 28376-7998
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Country | US
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Telephone | 910-878-5150
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Fax | 910-878-5190
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Authorized Official
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Title or Position | CEO
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Name | MICKEY FOSTER
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Credential |
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Telephone | 910-715-4473
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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