Provider Demographics
NPI:1295864197
Name:LOUISE H. BETHEA, M.D., PA
Entity Type:Organization
Organization Name:LOUISE H. BETHEA, M.D., PA
Other - Org Name:ALLERGY, ASTHMA AND IMMUNOLOGY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:H
Authorized Official - Last Name:BETHEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-580-6494
Mailing Address - Street 1:17070 RED OAK DR
Mailing Address - Street 2:107
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2619
Mailing Address - Country:US
Mailing Address - Phone:281-580-6494
Mailing Address - Fax:281-580-2038
Practice Address - Street 1:17198 ST LUKES WAY
Practice Address - Street 2:120
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-8011
Practice Address - Country:US
Practice Address - Phone:936-321-7140
Practice Address - Fax:936-321-7144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7699207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC13432Medicare UPIN
TX00935NMedicare ID - Type UnspecifiedMEDICARE