=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548276389
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRSTHEALTH OF THE CAROLINAS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2006
-----------------------------------------------------
Last Update Date | 01/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 522 ALLEN ST SUITE 101
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27371-2861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-571-5510
-----------------------------------------------------
Fax | 910-571-5772
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 522 ALLEN ST STE 101
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27371-2861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-571-5510
-----------------------------------------------------
Fax | 910-571-5572
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MICKEY FOSTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 910-715-4473
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 200401306
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------