Healthcare Provider Details

I. General information

NPI: 1407868334
Provider Name (Legal Business Name): FOX VALLEY HEMATOLOGY & ONCOLOGY, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 N GATEWAY DR
APPLETON WI
54913-7863
US

IV. Provider business mailing address

3232 N BALLARD RD SUITE 200
APPLETON WI
54911-8804
US

V. Phone/Fax

Practice location:
  • Phone: 920-749-1171
  • Fax: 920-749-1172
Mailing address:
  • Phone: 920-749-9668
  • Fax: 920-734-5307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number StateWI

VIII. Authorized Official

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