Active NPI
Fountain Healthcare Limited Liability Company
- Adult Medicine Physician
- Streator, IL
National Provider Identifier
1730425851
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Medicine Physician
- License
- 036099987
- Legal business name
- FOUNTAIN HEALTHCARE LIMITED LIABILITY COMPANY
- Practice address
- 1639 N 1590TH Rd
Streator, IL 61364-9644 - Phone
- (815) 793-6611
- Fax
- (630) 592-7500
- NPI assigned
- Dec 18, 2012
- Last updated
- Dec 18, 2012
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Mark Alan Wargo, M.D.
- Title
- Physician
- Phone
- (815) 793-6611
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Medicine Physician | 207QA0505X | 036099987 | IL | Primary |
Addresses
Primary practice location
1639 N 1590TH Rd
Streator, IL 61364-9644
Mailing address
1639 N 1590TH Rd
Streator, IL 61364-9644
Phone (815) 793-6611
National Provider Directory
National Provider Directory- Tax ID family
- Fountain Healthcare Limited Liability Company
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
dba LifeRx
- Family Medicine Physician
- Bloomington, IL
- NPI 1902140585
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1355788800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1355788800000",
"number": "1730425851",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1639 N 1590TH RD",
"city": "STREATOR",
"state": "IL",
"postal_code": "613649644",
"telephone_number": "815-793-6611",
"fax_number": "630-592-7500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1639 N 1590TH RD",
"city": "STREATOR",
"state": "IL",
"postal_code": "613649644",
"telephone_number": "815-793-6611",
"fax_number": "630-592-7500"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FOUNTAIN HEALTHCARE LIMITED LIABILITY COMPANY",
"organizational_subpart": "NO",
"enumeration_date": "2012-12-18",
"last_updated": "2012-12-18",
"status": "A",
"authorized_official_last_name": "WARGO",
"authorized_official_first_name": "MARK",
"authorized_official_middle_name": "ALAN",
"authorized_official_title_or_position": "PHYSICIAN",
"authorized_official_telephone_number": "815-793-6611",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207QA0505X",
"taxonomy_group": "",
"desc": "Family Medicine, Adult Medicine",
"state": "IL",
"license": "036099987",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Streator, IL
- Evergreen Streator, L.P. (Evergreen Place of Streator Supportive Living)
- Eye-Mart Inc.
- Eyemart Inc
- Finkelstein Eye Care PLLC
- Gary Richard Finkelstein, M.D.
- Fresenius Medical Care of Illinois, LLC (Fresenius Medical Care Streator)
- Julie Gabehart, P.T.
- Tomas Garbaliauskas, PHARMACIST
- Gary Finkelstein MD Eye Associates SC
- Elizabeth Gillette
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.