Healthcare Provider Details

I. General information

NPI: 1376594952
Provider Name (Legal Business Name): FOX VALLEY SURGICAL ASSOCIATES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E MILESTONE DR
APPLETON WI
54913-6701
US

IV. Provider business mailing address

2000 E MILESTONE DR
APPLETON WI
54913-6701
US

V. Phone/Fax

Practice location:
  • Phone: 920-731-8131
  • Fax: 920-832-0444
Mailing address:
  • Phone: 920-731-8131
  • Fax: 920-832-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: JACKIE BOYD
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 920-358-1729