Functional Medicine Center of Arizona

Primary specialty

Health & Wellness CoachTaxonomy code 171400000X

Legal business name

FUNCTIONAL MEDICINE CENTER OF ARIZONA

Practice address

806 S 56TH Ave Ste 1B
Phoenix, AZ 85043-4630

Phone

(602) 429-0447

NPI assigned

Apr 5, 2022

Organization subpart

No

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

Authorized official

Name

Anthony TiedemannNPI 1538801709

Title

Owner/Clinical Director

Phone

(480) 747-0499

Specialties & licenses 2

Addresses

Other names 1

• Functional Healthcare Center Other name

Electronic endpoints 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Anthony Tiedemann

  • Health & Wellness Coach
  • Phoenix, AZ
  • NPI 1538801709
  NPD Authorized official
• Lica Sert

  • EEG Specialist/Technologist
  • Phoenix, AZ
  • NPI 1669920849

  Health & Wellness Coach

  NPD

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

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649116800000",
    "number": "1235870205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 S 56TH AVE STE 1B",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850434630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "806 S 56TH AVE STE 1B",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850434630",
            "telephone_number": "602-429-0447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL MEDICINE CENTER OF ARIZONA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-05",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-04",
        "status": "A",
        "authorized_official_last_name": "TIEDEMANN",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "OWNER/CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "480-747-0499"
    },
    "taxonomies": [
        {
            "code": "171400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Health & Wellness Coach",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "office@elite2p.com",
            "affiliation": "N",
            "address_1": "806 S 56th Ave Ste 1B",
            "city": "Phoenix",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "850434630",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Functional Healthcare Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Yvonne Maria Funcke, MD
• Function First Psychiatry
• Functional Futures, LLC (Purposefully Home, LLC)
• Functional Health Systems S.C. (Paradise Village Chiropractic Center)
• Functional Investments, PLLC
• Isabel Marie Kaylin Funderburgh
• Erica Lynn Funderburk, MT-BC
• Cynthia M. Funes, PHD
• Cameron M Fung, DO
• Katherine Funk, MM, MT-BC, NMT

• Health & Wellness Coach in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Health & Wellness Coach in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; 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.