FOUNTAIN HEALTHCARE LIMITED LIABILITY COMPANY
NPI 1730425851
Family Medicine - Adult Medicine in Streator, IL

Q: What is Fountain Healthcare Limited Liability Company's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Adult Medicine, with taxonomy code 207QA0505X.

Active since December 18, 2012

1639 N 1590TH RD, STREATOR, IL 61364(815) 793-6611(630) 592-7500 Get Directions Write a Review

NPPES record last updated: December 18, 2012. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Fountain Healthcare Limited Liability Company NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FOUNTAIN HEALTHCARE LIMITED LIABILITY COMPANY (NPI 1730425851) is a healthcare organization registered as an adult medicine in Streator, Illinois and active in the NPI registry since December 2012. The organization lists Mark Alan Wargo, Physician, as its authorized official.

NPPES Registry Identity

NPI1730425851

Entity TypeOrganization

Primary Taxonomy207QA0505X

Legal Business NameFOUNTAIN HEALTHCARE LIMITED LIABILITY COMPANY

Location Address1639 N 1590TH RDStreator, IL 61364-9644

Mailing Address1639 N 1590th RdStreator, IL 61364-9644 · (815) 793-6611 · Fax (630) 592-7500

Phone(815) 793-6611

Fax(630) 592-7500

Organization SubpartNo

Authorized OfficialMark Alan WargoPhysician · (815) 793-6611

Enumeration DateDecember 18, 2012

✔ NPI 1730425851 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Adult MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207QA0505X

License✔ Licensed in IL · 036099987

Definition

The National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code.

1639 N 1590TH RD, Streator, IL 61364

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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Fountain Healthcare Limited Liability Company's NPI number?

The NPI number for Fountain Healthcare Limited Liability Company is 1730425851. It was assigned to this organization in the NPPES registry on December 18, 2012.

Where is Fountain Healthcare Limited Liability Company located?

Fountain Healthcare Limited Liability Company is located at 1639 N 1590th Rd, Streator, IL 61364. The listed phone number is (815) 793-6611.

What is Fountain Healthcare Limited Liability Company's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Adult Medicine, with taxonomy code 207QA0505X.

When was this NPI record last updated?

The NPPES record for Fountain Healthcare Limited Liability Company was last updated on December 18, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.