Center for Functional Medicine and Ultimate Wellness

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

CENTER FOR FUNCTIONAL MEDICINE AND ULTIMATE WELLNESS

Practice address

615 Commerce St
Fort Worth, TX 76102-5450

Phone

(817) 764-1148

NPI assigned

Jan 23, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. John Byron McClain Sr., MD

Title

Medical Director

Phone

(936) 240-0530

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1674432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674432000000",
    "number": "1194430371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1607 ARROWHEAD DR",
            "city": "PANTEGO",
            "state": "TX",
            "postal_code": "760133012",
            "telephone_number": "936-240-0530",
            "fax_number": "682-238-3509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 COMMERCE ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761025450",
            "telephone_number": "817-764-1148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR FUNCTIONAL MEDICINE AND ULTIMATE WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-23",
        "last_updated": "2023-01-23",
        "certification_date": "2023-01-18",
        "status": "A",
        "authorized_official_last_name": "MCCLAIN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "BYRON",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "936-240-0530",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.