FOUNTAIN HEALTHCARE LIMITED LIABILITY COMPANY


Address: 2412 E Washington St Ste 6, Bloomington, IL 61704-4497
Phone: 3095852116

FOUNTAIN HEALTHCARE LIMITED LIABILITY COMPANY (NPI# 1902140585) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1902140585
Entity Type Organization
Organization Name FOUNTAIN HEALTHCARE LIMITED LIABILITY COMPANY
Other Organization Name LIFERX
Practice Address 2412 E Washington St Ste 6
Bloomington
IL 61704-4497
Mailing Address 612 E Peru St
Princeton
IL 61356-1852
Practice Telephone 3095852116
Practice Fax Number 3095852152
Mailing Telephone 4157543379
Enumeration Date 2012-11-20
Last Update Date 2016-09-21
Authorized Official Name MR. CLYDE L BASS III (PRESIDENT)
Authorized Official Telephone 4157543379
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207Q00000X Family Medicine Allopathic & Osteopathic Physicians

Other Provider/Organization Names

Other Name Type Code
LifeRx Doing Business As Name - Organization

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1730425851 Fountain Healthcare Limited Liability Company Family Medicine 1639 N 1590th Rd, Streator, IL 61364-9644 2012-12-18

Office Location

Street Address 2412 E WASHINGTON ST STE 6
City BLOOMINGTON
State IL
Zip Code 61704-4497

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Taxonomy Information

Taxonomy Code 207Q00000X
Grouping Allopathic & Osteopathic Physicians
Classification Family Medicine

Taxonomy Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition]
- Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences.
- Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine.

Providers in the same taxonomy and city

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1073165650 Genevieve Elon Monge Family Medicine 18651 Valley Blvd, Bloomington, CA 92316-1831 2019-07-12
1982117172 Andry Medical Services Family Medicine 451 S Park Ridge Rd Ste 101, Bloomington, IN 47401-8589 2017-11-09
1033459904 Charles R Farmer Family Medicine 3480 S Oak Ridge Dr, Bloomington, IN 47401-8926 2013-02-28
1467798504 James Anthony Ray Family Medicine 2001 E Hillside Dr Lot 4, Bloomington, IN 47401-6692 2012-12-18
1306147236 Community Health Network Family Medicine 524 N Fairview St, Bloomington, IN 47404-3774 2010-11-09
1942501978 Premier Medical Group, LLC Family Medicine 2102 E Washington St, Bloomington, IL 61701-4321 2010-11-08
1356660666 Glen Edward Tomlinson Family Medicine 42 Crista Ann Ct, Bloomington, IL 61704-8699 2010-05-26
1285862664 Charles W Mcclary Family Medicine 1411 S Sare Rd, Bloomington, IN 47401-4431 2009-06-24
1982840005 Thomas Patterson Cairns Family Medicine 10258 Berkshire Rd, Bloomington, MN 55437-2265 2008-12-18
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Competitor

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City BLOOMINGTON
Zip Code 61704

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Dataset Information

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.

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