Provider Demographics
NPI:1346295920
Name:FARRELL, AINSWORTH B (MD)
Entity Type:Individual
Prefix:
First Name:AINSWORTH
Middle Name:B
Last Name:FARRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2757
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0051
Mailing Address - Country:US
Mailing Address - Phone:214-544-9887
Mailing Address - Fax:214-544-9888
Practice Address - Street 1:6850 TPC DR STE 110
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-3145
Practice Address - Country:US
Practice Address - Phone:214-544-9887
Practice Address - Fax:214-544-9888
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057456208100000X
TXN20702081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX214893401Medicaid
TX214893402Medicaid
GA696884648BMedicaid
GA696884648AMedicaid
TX214893403Medicaid
TX8L27489Medicare PIN
GA696884648BMedicaid
TXTXB100020Medicare PIN
GAI52437Medicare UPIN
TX8L27490Medicare PIN