Provider Demographics
NPI:1881012243
Name:FUNCTIONAL HEALTH AND MEDICINE, LLC
Entity Type:Organization
Organization Name:FUNCTIONAL HEALTH AND MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-512-0907
Mailing Address - Street 1:1720 SE 16TH AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4620
Mailing Address - Country:US
Mailing Address - Phone:352-512-0907
Mailing Address - Fax:352-512-0976
Practice Address - Street 1:1720 SE 16TH AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4620
Practice Address - Country:US
Practice Address - Phone:352-512-0907
Practice Address - Fax:352-512-0976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 12487204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty