Healthcare Provider Details

I. General information

NPI: 1366716813
Provider Name (Legal Business Name): FRISCO PAIN CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7589 PRESTON RD STE 900
FRISCO TX
75034-5676
US

IV. Provider business mailing address

7589 PRESTON RD STE 900
FRISCO TX
75034-5676
US

V. Phone/Fax

Practice location:
  • Phone: 214-705-7749
  • Fax: 214-705-7729
Mailing address:
  • Phone: 214-705-7749
  • Fax: 214-705-7729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License NumberK1092
License Number StateTX

VIII. Authorized Official

Name: DR. MOHAMMAD TARIQ
Title or Position: OWNER
Credential: MD
Phone: 214-705-7749