1942294244 NPI number — BURLINGTON PEDIATRIC ASSOCIATION, P.C.

Table of content: (NPI 1942294244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942294244 NPI number — BURLINGTON PEDIATRIC ASSOCIATION, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BURLINGTON PEDIATRIC ASSOCIATION, P.C.
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:
1942294244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1223 S GEAR AVE
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
WEST BURLINGTON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52655-1685
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-753-5177
Provider Business Mailing Address Fax Number:
319-753-0893

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1223 S GEAR AVE
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
WEST BURLINGTON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52655-1685
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-753-5177
Provider Business Practice Location Address Fax Number:
319-753-0893
Provider Enumeration Date:
09/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MCCABE
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
319-753-5177

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  18676 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0150573 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0161166 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 15057 . This is a "WELLMARK BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 00733 . This is a "DR. FRANCES JACKSON" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0065342 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0127167 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12716 . This is a "DR. DONALD MCCABE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 16116 . This is a "DR. WILLIAMS DAWS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 16115 . This is a "DR. JAMES HENDRIX" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0161158 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com