| Fountain Healthcare Limited Liability Company | |
|
1639 N 1590th Rd Streator IL 61364-9644 | |
| (815) 793-6611 | |
| (630) 592-7500 |
| Full Name | Fountain Healthcare Limited Liability Company |
|---|---|
| Speciality | Family Medicine - Adult Medicine |
| Location | 1639 N 1590th Rd, Streator, Illinois |
| Authorized Official Name and Position | Mark Alan Wargo (PHYSICIAN) |
| Authorized Official Contact | 8157936611 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fountain Healthcare Limited Liability Company 1639 N 1590th Rd Streator IL 61364-9644 Ph: (815) 793-6611 | Fountain Healthcare Limited Liability Company 1639 N 1590th Rd Streator IL 61364-9644 Ph: (815) 793-6611 |
| NPI Number | 1730425851 |
|---|---|
| Provider Enumeration Date | 12/18/2012 |
| Last Update Date | 12/18/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730425851 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | 036099987 (Illinois) | Primary |
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