Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 S WASHBURN ST SUITE 100
OSHKOSH WI
54904-6733
US

IV. Provider business mailing address

3232 N BALLARD RD
APPLETON WI
54911-8804
US

V. Phone/Fax

Practice location:
  • Phone: 920-292-5555
  • Fax: 920-292-1717
Mailing address:
  • Phone: 920-749-9668
  • Fax: 920-734-5307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 3
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