1255448254 NPI number — MCCAIN ORTHOPAEDIC CLINIC, P.A.

Table of content: (NPI 1255448254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255448254 NPI number — MCCAIN ORTHOPAEDIC CLINIC, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCCAIN ORTHOPAEDIC CLINIC, P.A.
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:
Provider Other Organization Name Type Code:
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:
1255448254
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4509 EAST MCCAIN BLVD
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
NORTH LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72117-2902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-945-4221
Provider Business Mailing Address Fax Number:
501-945-8824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4509 EAST MCCAIN BLVD
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
NORTH LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72117-2902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-945-4221
Provider Business Practice Location Address Fax Number:
501-945-8824
Provider Enumeration Date:
08/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROONEY
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
501-945-4221

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 105181002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com