| Mcpc-29, LLC | |
|
155 Memorial Dr Pinehurst NC 28374-8710 | |
| (910) 715-1000 | |
| Not Available |
| Full Name | Mcpc-29, LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 155 Memorial Dr, Pinehurst, North Carolina |
| Authorized Official Name and Position | Mickey Foster (CEO) |
| Authorized Official Contact | 9107154473 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mcpc-29, LLC 155 Memorial Dr Pinehurst NC 28374-8710 Ph: (910) 715-1000 | Mcpc-29, LLC 155 Memorial Dr Pinehurst NC 28374-8710 Ph: (910) 715-1000 |
| NPI Number | 1053299867 |
|---|---|
| Provider Enumeration Date | 08/21/2025 |
| Last Update Date | 08/21/2025 |
| Certification Date | 08/21/2025 |
| Medicare PECOS PAC ID | 3870071053 |
|---|---|
| Medicare Enrollment ID | O20260129001896 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053299867 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Julie T Coggins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023566544 PECOS PAC ID: 3678852092 Enrollment ID: I20161108000290 |
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