Provider Demographics
NPI:1457658833
Name:FUNCTIONALMED.ORG
Entity Type:Organization
Organization Name:FUNCTIONALMED.ORG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOOLVERTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-877-7767
Mailing Address - Street 1:9710 COUNTY ROAD 2426
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-8825
Mailing Address - Country:US
Mailing Address - Phone:972-877-7767
Mailing Address - Fax:972-767-0939
Practice Address - Street 1:9710 COUNTY ROAD 2426
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-8825
Practice Address - Country:US
Practice Address - Phone:972-877-7767
Practice Address - Fax:972-767-0939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-19
Last Update Date:2011-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No251V00000XAgenciesVoluntary or Charitable