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General NPI Number Information
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NPI Number | 1942781455
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Entity Type | Organization
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Legal Business Name | MCPC-19, LLC
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Dates
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Enumeration Date | 08/23/2018
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 2919 BEECHTREE DR STE 1200
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City | SANFORD
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State | NC
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Zip | 27330-6934
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Country | US
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Telephone | 919-897-2265
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Fax | 919-897-2266
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Provider Business Mailing Address
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Address Line | 2919 BEECHTREE DR STE 1200
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City | SANFORD
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State | NC
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Zip | 27330-6934
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Country | US
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Telephone | 919-897-2265
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Fax | 919-897-2266
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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