MEDICARE: FUNCTIONAL MED HEALTH SYSTEMS MANAGEMENT

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	111N00000X	Chiropractor
2	111NN1001X	Nutrition Chiropractor
3	111NS0005X	Sports Physician Chiropractor
4	133V00000X	Registered Dietitian
5	171100000X	Acupuncturist
6	171M00000X	Case Manager/Care Coordinator
7	174H00000X	Health Educator
8	208100000X	Physical Medicine & Rehabilitation Physician
9	251E00000X	Home Health Agency
10	251J00000X	Nursing Care Agency
11	314000000X	Skilled Nursing Facility
12	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1972080091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUNCTIONAL MED HEALTH SYSTEMS MANAGEMENT

Provider Business Mailing Address
First Line	:	PO BOX 2498
Second Line	:
City	:	ROCKWALL
State	:	TX
Zip	:	75087-8598
Country	:	US
Telephone Number	:	972-877-9028
Fax Number	:	877-779-1769

Provider Business Practice Location Address
First Line	:	9710 COUNTY ROAD 2426
Second Line	:
City	:	TERRELL
State	:	TX
Zip	:	75160-8825
Country	:	US
Telephone Number	:	972-977-0587
Fax Number	:	877-779-1769

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MRS. BRITTNEY MARIE WEBER
Credential	:
Telephone Number	:	972-977-0587

Provider Enumeration Date	:	07/21/2018
Last Update Date	:	07/21/2018

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Directions to “FUNCTIONAL MED HEALTH SYSTEMS MANAGEMENT ” Practice Location

Language	Start Address	Practice Location

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