MEDICARE: MCPC-8, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician
2	208VP0000X	Pain Medicine Physician

General Provider Information

NPI Number	:	1417216110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCPC-8, LLC

Provider Business Mailing Address
First Line	:	4565 FAYETTEVILLE ROAD
Second Line	:	SUITE B
City	:	RAEFORD
State	:	NC
Zip	:	28376-0000
Country	:	US
Telephone Number	:	910-878-5150
Fax Number	:	910-878-5190

Provider Business Practice Location Address
First Line	:	4565 FAYETTEVILLE ROAD
Second Line	:	SUITE B
City	:	RAEFORD
State	:	NC
Zip	:	28376-0000
Country	:	US
Telephone Number	:	910-878-5150
Fax Number	:	910-878-5190

Authorized Official
Title or Position	:	CEO
Name	:	MICKEY FOSTER
Credential	:
Telephone Number	:	910-715-4473

Provider Enumeration Date	:	05/15/2012
Last Update Date	:	12/04/2024

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