Provider Demographics
NPI:1891770731
Name:DENTON PHYSICAL MEDICINE PAIN
Entity Type:Organization
Organization Name:DENTON PHYSICAL MEDICINE PAIN
Other - Org Name:PARCHELLE D CONNALLY MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PARCHELLE
Authorized Official - Middle Name:DENIESE
Authorized Official - Last Name:CONNALLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-539-1200
Mailing Address - Street 1:5801 SHOREFRONT LN
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-5698
Mailing Address - Country:US
Mailing Address - Phone:972-539-1200
Mailing Address - Fax:972-539-1221
Practice Address - Street 1:4320 WINDSOR CENTRE TRL
Practice Address - Street 2:STE 300
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1858
Practice Address - Country:US
Practice Address - Phone:972-539-1200
Practice Address - Fax:972-539-1221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8969208100000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX036324401Medicaid
TX036324401Medicaid
C47326Medicare UPIN