Provider Demographics
NPI:1194795450
Name:MCGOVERN ALLERGY CLINIC, P.A.
Entity type:Organization
Organization Name:MCGOVERN ALLERGY CLINIC, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DORRETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-662-5573
Mailing Address - Street 1:4710 BELLAIRE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4526
Mailing Address - Country:US
Mailing Address - Phone:713-661-1444
Mailing Address - Fax:713-661-6604
Practice Address - Street 1:4710 BELLAIRE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4526
Practice Address - Country:US
Practice Address - Phone:713-661-1444
Practice Address - Fax:713-661-6604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX082336101Medicaid
TX082336101Medicaid
TX00ES17Medicare PIN