Healthcare Provider Details

I. General information

NPI: 1497011043
Provider Name (Legal Business Name): CONQUESTMD SPINE CARE AND SPORTS MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 TPC DR STE 110
MCKINNEY TX
75070-3145
US

IV. Provider business mailing address

PO BOX 2757
FRISCO TX
75034-0051
US

V. Phone/Fax

Practice location:
  • Phone: 214-544-9887
  • Fax: 214-544-9888
Mailing address:
  • Phone: 214-544-9887
  • Fax: 214-544-9888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberN2070
License Number StateTX

VIII. Authorized Official

Name: AINSWORTH FARRELL
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 214-544-9887