Fountains Infusion Center LLC

Primary specialty

Infusion Therapy Clinic/CenterTaxonomy code 261QI0500X

Legal business name

FOUNTAINS INFUSION CENTER LLC

Practice address

159 Fountains Blvd Ste D
Madison, MS 39110-6344

Phone

(601) 859-8200

Fax

(601) 859-8201

NPI assigned

Apr 30, 2019

Last updated

Apr 30, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

George W Phillips

Title

Member

Phone

(601) 859-8200

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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.

• Mallory Elizabeth Boggs, A-GNP-C

  • Primary Care Nurse Practitioner
  • Madison, MS
  • NPI 1013543388
  Medicare reassignment NPD
• Heather Hontzas

  • Nurse Practitioner
  • Madison, MS
  • NPI 1083266779
  Medicare reassignment NPD

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

{
    "created_epoch": "1556582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556582400000",
    "number": "1467016931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "159 FOUNTAINS BLVD STE D",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106344",
            "telephone_number": "601-859-8200",
            "fax_number": "601-859-8201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 FOUNTAINS BLVD STE D",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106344",
            "telephone_number": "601-859-8200",
            "fax_number": "601-859-8201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAINS INFUSION CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-30",
        "last_updated": "2019-04-30",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "601-859-8200"
    },
    "taxonomies": [
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Flowood River Oaks Hma Medical Group, LLC (CarePlus Madison Family Medicine)
• Chancey Fort, LPC, RPT, NCC, NCSC
• William Coleman Fortenberry, DMD
• Brandon Sloane Fortinberry, D.C.
• Mary Rebecca Foster, CCC-A
• Tyler Fuller, PHARMD
• John Christopher Funkhouser, N.P.
• G Gives Consulting LLC
• Lorraine Gaddis, CFNP
• Latanya Smoot Galloway

• Infusion Therapy Clinic/Center in Madison, MS
• Providers in Madison, MS by specialty
• Infusion Therapy Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.