1457604902 NPI number — MCPC-5, LLC

Table of content: NICHOLAS ROBERT GARCIA DPM (NPI 1528621927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457604902 NPI number — MCPC-5, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCPC-5, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FIRSTHEALTH CARDIOLOGY SERVICES--HOKE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457604902
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 843232
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02284-3232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-878-5150
Provider Business Mailing Address Fax Number:
910-878-5190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4565 FAYETTEVILLE RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
RAEFORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28376-7998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-878-5180
Provider Business Practice Location Address Fax Number:
910-255-1104
Provider Enumeration Date:
10/22/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DEJACO
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
910-715-1913

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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