Fountain Healthcare Limited Liability Company
NPI #1902140585 in Bloomington, Illinois
Provider Information
- NPI Number
- 1902140585
- Entity Type
- Organization
- Organization Name
- Fountain Healthcare Limited Liability Company
- Primary Specialty
- Family Medicine
- Enumeration Date
- Nov 20, 2012
- Last Updated
- Sep 21, 2016
Practice Location
- Address
- 2412 E WASHINGTON ST STE 6
- City
- Bloomington
- State
- Illinois
- ZIP Code
- 61704-4497
- Phone
- (309) 585-2116
Authorized Official
- Name
- MR. CLYDE L BASS III
- Title
- PRESIDENT
- Phone
- (415) 754-3379
Specialties & Taxonomy Codes
| Specialty |
|---|
| Family Medicine |
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