Basic Information
| Provider Information | |||||||||
| NPI: | 1003401217 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCPC-8, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 896208 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282896208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107151010 | ||||||||
| FaxNumber: | 9107151026 | ||||||||
| Practice Location | |||||||||
| Address1: | 3110 S HORNER BLVD | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273328212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198423570 | ||||||||
| FaxNumber: | 9198425113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2021 | ||||||||
| LastUpdateDate: | 03/11/2021 | ||||||||
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| AuthorizedOfficialLastName: | FOSTER | ||||||||
| AuthorizedOfficialFirstName: | MICKEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9107151000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.