Provider Demographics
NPI:1255448254
Name:MCCAIN ORTHOPAEDIC CLINIC, P.A.
Entity type:Organization
Organization Name:MCCAIN ORTHOPAEDIC CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:ROONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-945-4221
Mailing Address - Street 1:4509 EAST MCCAIN BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2902
Mailing Address - Country:US
Mailing Address - Phone:501-945-4221
Mailing Address - Fax:501-945-8824
Practice Address - Street 1:4509 EAST MCCAIN BLVD
Practice Address - Street 2:STE A
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2902
Practice Address - Country:US
Practice Address - Phone:501-945-4221
Practice Address - Fax:501-945-8824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105181002Medicaid
0652300001Medicare NSC
AR105181002Medicaid