MEDICARE: FOX VALLEY HEMATOLOGY & ONCOLOGY, S.C.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	332900000X	Non-Pharmacy Dispensing Site	WI
2	207R00000X	Internal Medicine Physician
3	207RH0003X	Hematology & Oncology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08868300006	OTHER	WI	DMEPOS - DMEMAC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942323407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOX VALLEY HEMATOLOGY & ONCOLOGY, S.C.

Provider Business Mailing Address
First Line	:	3232 N BALLARD RD
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54911-8804
Country	:	US
Telephone Number	:	920-749-9668
Fax Number	:	920-734-5307

Provider Business Practice Location Address
First Line	:	491 S WASHBURN ST
Second Line	:	SUITE 100
City	:	OSHKOSH
State	:	WI
Zip	:	54904-6733
Country	:	US
Telephone Number	:	920-292-5555
Fax Number	:	920-292-1717

Authorized Official
Title or Position	:	CHIEF MEDICAL OFFICER/PHYSICIAN
Name	:	TIMOTHY F GOGGINS
Credential	:	M.D.
Telephone Number	:	920-749-1171

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	02/07/2017

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Directions to “FOX VALLEY HEMATOLOGY & ONCOLOGY, S.C. ” Practice Location

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