Provider Demographics
NPI:1942294244
Name:BURLINGTON PEDIATRIC ASSOCIATION, P.C.
Entity Type:Organization
Organization Name:BURLINGTON PEDIATRIC ASSOCIATION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCCABE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-753-5177
Mailing Address - Street 1:1223 S GEAR AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1685
Mailing Address - Country:US
Mailing Address - Phone:319-753-5177
Mailing Address - Fax:319-753-0893
Practice Address - Street 1:1223 S GEAR AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1685
Practice Address - Country:US
Practice Address - Phone:319-753-5177
Practice Address - Fax:319-753-0893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18676208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0150573Medicaid
IA0161166Medicaid
IA15057OtherWELLMARK BCBS
IA00733OtherDR. FRANCES JACKSON
IA0065342Medicaid
IA0127167Medicaid
IA12716OtherDR. DONALD MCCABE
IA16116OtherDR. WILLIAMS DAWS
IA16115OtherDR. JAMES HENDRIX
IA0161158Medicaid
IA12716OtherDR. DONALD MCCABE
IA00733OtherDR. FRANCES JACKSON
IA0127167Medicaid
IA0161166Medicaid