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General NPI Number Information
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NPI Number | 1790191765
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Entity Type | Organization
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Legal Business Name | MCPC-5, LLC
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Dates
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Enumeration Date | 07/10/2014
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 812 CANDY PARK RD
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City | PEMBROKE
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State | NC
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Zip | 28372-9120
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Country | US
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Telephone | 910-417-4105
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Fax | 910-417-4120
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Provider Business Mailing Address
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Address Line | PO BOX 896208
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City | CHARLOTTE
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State | NC
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Zip | 28289-6208
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Country | US
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Telephone | 910-417-4105
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Fax | 910-417-4120
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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