MEDICARE: FUNCTIONALMED.ORG

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	251J00000X	Nursing Care Agency
3	251V00000X	Voluntary or Charitable Agency
4	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1457658833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUNCTIONALMED.ORG

Provider Business Mailing Address
First Line	:	9710 COUNTY ROAD 2426
Second Line	:
City	:	TERRELL
State	:	TX
Zip	:	75160-8825
Country	:	US
Telephone Number	:	972-877-7767
Fax Number	:	972-767-0939

Provider Business Practice Location Address
First Line	:	9710 COUNTY ROAD 2426
Second Line	:
City	:	TERRELL
State	:	TX
Zip	:	75160-8825
Country	:	US
Telephone Number	:	972-877-7767
Fax Number	:	972-767-0939

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DR. DIANA D WOOLVERTON
Credential	:	D.C.
Telephone Number	:	972-877-7767

Provider Enumeration Date	:	02/19/2011
Last Update Date	:	02/19/2011

Similar Medicare Providers

1720085780 — DR. DIANA WOOLVERTON D.C.
Practice Location Address:

9710 COUNTY ROAD 2426
TERRELL, TX
75160-8825

Practice Phone: 972-877-7767
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1972080091 — FUNCTIONAL MED HEALTH SYSTEMS MANAGEMENT
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1891346870 — PATIENT CENTERED HEALTH GROUP
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1578492518 — ASHLEY MARIE MURRAY HIS
Practice Location Address:

808 W MOORE AVE STE A
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1508868639 — RENAISSANCE HOSPITAL TERRELL INC
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1821092719 — EULALIA DARLENE JOHNSON DC
Practice Location Address:

1409 W MOORE AVE
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Directions to “FUNCTIONALMED.ORG ” Practice Location

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