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General NPI Number Information
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NPI Number | 1497011043
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Entity Type | Organization
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Legal Business Name | CONQUESTMD SPINE CARE AND SPORTS MEDICINE, PLLC
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Dates
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Enumeration Date | 04/09/2012
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 6850 TPC DR STE 110
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City | MCKINNEY
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State | TX
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Zip | 75070-3145
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Country | US
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Telephone | 214-544-9887
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Fax | 214-544-9888
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Provider Business Mailing Address
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Address Line | PO BOX 2757
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City | FRISCO
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State | TX
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Zip | 75034-0051
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Country | US
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Telephone | 214-544-9887
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Fax | 214-544-9888
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Authorized Official
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Title or Position | PHYSICIAN
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Name | AINSWORTH FARRELL
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Credential | M.D.
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Telephone | 214-544-9887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | N2070
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License Number State | TX
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