| Center For Functional Medicine And Ultimate Wellness | |
|
615 Commerce St Fort Worth TX 76102-5450 | |
| (817) 764-1148 | |
| Not Available |
| Full Name | Center For Functional Medicine And Ultimate Wellness |
|---|---|
| Speciality | Clinic/Center |
| Location | 615 Commerce St, Fort Worth, Texas |
| Authorized Official Name and Position | John Byron Mcclain (MEDICAL DIRECTOR) |
| Authorized Official Contact | 9362400530 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Center For Functional Medicine And Ultimate Wellness 1607 Arrowhead Dr Pantego TX 76013-3012 Ph: (936) 240-0530 | Center For Functional Medicine And Ultimate Wellness 615 Commerce St Fort Worth TX 76102-5450 Ph: (817) 764-1148 |
| NPI Number | 1194430371 |
|---|---|
| Provider Enumeration Date | 01/23/2023 |
| Last Update Date | 01/23/2023 |
| Medicare PECOS PAC ID | 8921461146 |
|---|---|
| Medicare Enrollment ID | O20230905003553 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194430371 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | John Byron Mcclain |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467520122 PECOS PAC ID: 2264565043 Enrollment ID: I20100730000120 |
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