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General NPI Number Information
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NPI Number | 1114155983
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Entity Type | Organization
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Legal Business Name | FOX VALLEY VEIN CENTERS, P.C.
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 06/30/2009
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Provider Practice Location Address
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Address Line | 831 SANDHURST DR
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City | SANDWICH
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State | IL
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Zip | 60548-1390
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Country | US
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Telephone | 815-786-3222
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Fax |
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Provider Business Mailing Address
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Address Line | 831 SANDHURST DR
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City | SANDWICH
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State | IL
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Zip | 60548-1390
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Country | US
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Telephone | 815-786-3222
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER/PHYSICIAN
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Name | DR. JAMES N HAWKINS
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Credential | D.O.
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Telephone | 815-786-3222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 036083779
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License Number State | IL
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