Provider Demographics
NPI:1386920833
Name:FRISCO PAIN CENTER LLC
Entity type:Organization
Organization Name:FRISCO PAIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:JAVED
Authorized Official - Last Name:TARIQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-705-7749
Mailing Address - Street 1:7589 PRESTON RD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-5667
Mailing Address - Country:US
Mailing Address - Phone:214-705-7749
Mailing Address - Fax:214-705-7729
Practice Address - Street 1:7589 PRESTON RD
Practice Address - Street 2:SUITE 900
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5667
Practice Address - Country:US
Practice Address - Phone:214-705-7749
Practice Address - Fax:214-705-7729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX698485367500000X
TX579608367500000X
TX651757367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992985998OtherNPI
1851493423OtherNPI
1598725244OtherNPI