MEDICARE: ROOT CAUSE FUNCTIONAL MEDICINE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1780510297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROOT CAUSE FUNCTIONAL MEDICINE, PLLC

Provider Business Mailing Address
First Line	:	1800 E 4TH ST UNIT 101
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78702-4448
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 E 4TH ST UNIT 101
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78702-4448
Country	:	US
Telephone Number	:	470-924-2915
Fax Number	:

Authorized Official
Title or Position	:	CHIEF ADMINISTRATIVE OFFICER
Name	:	ROBERT HICKEY
Credential	:
Telephone Number	:	717-729-6208

Provider Enumeration Date	:	06/22/2026
Last Update Date	:	06/22/2026

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