Basic Information
| Provider Information | |||||||||
| NPI: | 1376819037 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCPC-6, LLC | ||||||||
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| OtherOrganizationName: | FIRSTHEALTH BACK AND NECK PAIN CENTER-SANFORD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1227 CARTHAGE ST | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273308984 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197740665 | ||||||||
| FaxNumber: | 9197085152 | ||||||||
| Practice Location | |||||||||
| Address1: | 1227 CARTHAGE ST | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273308984 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197740665 | ||||||||
| FaxNumber: | 9197085152 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2012 | ||||||||
| LastUpdateDate: | 09/14/2012 | ||||||||
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| AuthorizedOfficialLastName: | DEJACO | ||||||||
| AuthorizedOfficialFirstName: | LYNN | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9107151913 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.