MEDICARE: FOX VALLEY EAR, NOSE AND THROAT, ASSOC., S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CF4185	OTHER	IL	MEDICARE RAILROAD PTAN

General Provider Information

NPI Number	:	1851326797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOX VALLEY EAR, NOSE AND THROAT, ASSOC., S.C.

Provider Business Mailing Address
First Line	:	2210 DEAN ST
Second Line	:	SUITE L
City	:	SAINT CHARLES
State	:	IL
Zip	:	60175-1066
Country	:	US
Telephone Number	:	630-377-5000
Fax Number	:	630-377-5028

Provider Business Practice Location Address
First Line	:	2210 DEAN ST
Second Line	:	SUITE L
City	:	SAINT CHARLES
State	:	IL
Zip	:	60175-1066
Country	:	US
Telephone Number	:	630-377-5000
Fax Number	:	630-377-5028

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID S. HEMMER
Credential	:	MD
Telephone Number	:	630-377-5000

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/21/2022

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