Provider Demographics
NPI:1235679135
Name:FOX MEDICAL
Entity Type:Organization
Organization Name:FOX MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:936-661-2584
Mailing Address - Street 1:3011 HIGHWAY 30 W STE 101-117
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-3534
Mailing Address - Country:US
Mailing Address - Phone:936-295-1777
Mailing Address - Fax:
Practice Address - Street 1:540 I-45 SOUTH
Practice Address - Street 2:SUITE B
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340
Practice Address - Country:US
Practice Address - Phone:936-295-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty