Provider Demographics
NPI:1194841296
Name:FOX VALLEY HEARING CENTER
Entity Type:Organization
Organization Name:FOX VALLEY HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGINNIS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:920-233-1800
Mailing Address - Street 1:1820 W POINTE DR
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-4164
Mailing Address - Country:US
Mailing Address - Phone:920-233-1800
Mailing Address - Fax:920-233-1538
Practice Address - Street 1:1820 W POINTE DR
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-4164
Practice Address - Country:US
Practice Address - Phone:920-233-1800
Practice Address - Fax:920-233-1538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41117600Medicaid
WI41117600Medicaid