FOUNTAIN HEALTHCARE LIMITED LIABILITY COMPANY (NPI# 1730425851) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730425851 |
| Entity Type | Organization |
| Organization Name | FOUNTAIN HEALTHCARE LIMITED LIABILITY COMPANY |
| Practice Address |
1639 N 1590th Rd Streator IL 61364-9644 |
| Practice Telephone | 8157936611 |
| Practice Fax Number | 6305927500 |
| Mailing Telephone | 8157936611 |
| Mailing Fax Number | 6305927500 |
| Enumeration Date | 2012-12-18 |
| Last Update Date | 2012-12-18 |
| Authorized Official Name | DR. MARK ALAN WARGO (PHYSICIAN) |
| Authorized Official Telephone | 8157936611 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QA0505X |
Family Medicine Specialization: Adult Medicine |
036099987 | IL | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902140585 | Fountain Healthcare Limited Liability Company | Family Medicine | 2412 E Washington St Ste 6, Bloomington, IL 61704-4497 | 2012-11-20 |
| Street Address |
1639 N 1590TH RD |
| City | STREATOR |
| State | IL |
| Zip Code | 61364-9644 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093110066 | Ottawa Friendship House Work Activity Center, Inc | Intermediate Care Facility, Mentally Retarded | 600 West 12th Street, Streator, IL 61364 | 2014-11-03 |
| 1306278973 | Robert Henry Harms | Veterinarian | 701 Oakley Ave, Streator, IL 61364 | 2013-08-06 |
| 1518202373 | Jessica L Hartman | Nurse Practitioner | 2377 N Bloomington St, Streator, IL 61364 | 2012-12-05 |
| 1992049563 | Wendell Allen Sargent | Dentist | 106 Boys St, Streator, IL 61364 | 2012-11-20 |
| 1215266036 | Sudha Pravinkumar | Internal Medicine | 2377 Bloomington Ave, Ste B, Streator, IL 61364 | 2009-12-08 |
| 1497988984 | Lifetime Medical Supply Inc. | Durable Medical Equipment & Medical Supplies | 1215 N Ottercreek Rd., Streator, IL 61364 | 2009-08-31 |
| 1275709727 | Fresenius Medical Care of Illinois LLC | Clinic/Center | 2356 North Bloomington St, Streator, IL 61364 | 2008-05-05 |
| 1487701793 | Tammy R Thieme | Social Worker | 17 North Point Plaza, Streator, IL 61364 | 2007-01-05 |
| 1629185376 | Gary Finkelstein Md Eye Associates Sc | Ophthalmology | 102 West Elm Street, Streator, IL 61364 | 2006-08-25 |
| 1134150808 | Indra Pal Mdsc | Internal Medicine | 104 Sixth Street, Streator, IL 61364 | 2006-07-05 |
| Find all providers in zip 61364 | ||||
| Taxonomy Code | 207QA0505X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Adult Medicine |
| Definition to come. |
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| 1699277038 | Eileen A Solis | Family Medicine | 1795 Grandstand Pl Ste 2, Elgin, IL 60123-4980 | 2018-03-01 |
| 1841703584 | Home Physicians of Illinois LLC | Family Medicine | 10027 Frontage Rd, Skokie, IL 60077-1033 | 2017-11-15 |
| 1770953986 | Mrs Integrative Medicine LLC | Family Medicine | 3s630 Glen Dr S, Warrenville, IL 60555-3506 | 2015-09-30 |
| 1447666318 | M & F Medical Services, Ltd | Family Medicine | 5642 N Christiana Ave, Chicago, IL 60659-4555 | 2014-07-10 |
| 1457767774 | Rambha Radhakrishnan | Family Medicine | 2645 W Peterson Ave, Chicago, IL 60659-4017 | 2014-07-08 |
| 1851733133 | Pyramids Advisors, Inc. | Family Medicine | 6427 Dempster St, Morton Grove, IL 60053-2604 | 2013-07-26 |
| 1558707075 | Jean M. Pouget | Family Medicine | 175 Northgate Rd, Riverside, Riverside, IL 60546-1683 | 2013-05-13 |
| 1629411806 | Rahman Fazil Mohammed Abdul | Family Medicine | 9011 W Ballard Rd Apt 1a, Des Plaines, IL 60016-4987 | 2013-04-08 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.