Healthcare Provider Details

I. General information

NPI: 1417358714
Provider Name (Legal Business Name): FUNCTIONAL HEALTH SYSTEMS S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2014
Last Update Date: 09/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13835 N TATUM BLVD STE 3
PHOENIX AZ
85032-5579
US

IV. Provider business mailing address

13835 N TATUM BLVD STE 3
PHOENIX AZ
85032-5579
US

V. Phone/Fax

Practice location:
  • Phone: 602-953-1900
  • Fax: 602-953-1901
Mailing address:
  • Phone: 602-953-1900
  • Fax: 602-953-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number8355
License Number StateAZ

VIII. Authorized Official

Name: DR. SCOTT CARMACHEL
Title or Position: OWNER/DIRECTOR
Credential: DC
Phone: 602-953-1900