Provider Demographics
NPI:1013993286
Name:MCCABE, PATRICK B (PA-C)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:B
Last Name:MCCABE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 W UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-3009
Mailing Address - Country:US
Mailing Address - Phone:208-336-8250
Mailing Address - Fax:208-345-9514
Practice Address - Street 1:1188 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706
Practice Address - Country:US
Practice Address - Phone:208-336-8250
Practice Address - Fax:208-345-9514
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-387363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1013993286Medicaid
ID000010138648OtherBLUE SHIELD
IDPACE7OtherBLUE CROSS
ID000010138649OtherBLUE SHIELD
IDPACD0OtherBLUE CROSS
ID970026919OtherRAILROAD MEDICARE
ID000010138649OtherBLUE SHIELD
IDPACD0OtherBLUE CROSS