1194795450 NPI number — MCGOVERN ALLERGY CLINIC, P.A.

Table of content: (NPI 1194795450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194795450 NPI number — MCGOVERN ALLERGY CLINIC, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCGOVERN ALLERGY 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:
6
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:
1194795450
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4710 BELLAIRE BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
BELLAIRE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77401-4526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-661-1444
Provider Business Mailing Address Fax Number:
713-661-6604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4710 BELLAIRE BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BELLAIRE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77401-4526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-661-1444
Provider Business Practice Location Address Fax Number:
713-661-6604
Provider Enumeration Date:
01/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LITTLETON
Authorized Official First Name:
DORRETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
713-662-5573

Provider Taxonomy Codes

  • Taxonomy code: 207KI0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 082336101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com