Provider Demographics
NPI:1336323062
Name:FOX VALLEY PAIN CENTER S.C.
Entity Type:Organization
Organization Name:FOX VALLEY PAIN CENTER S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANGER
Authorized Official - Prefix:
Authorized Official - First Name:MURTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-584-8391
Mailing Address - Street 1:1710 N RANDALL RD
Mailing Address - Street 2:SUITE 370
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-9400
Mailing Address - Country:US
Mailing Address - Phone:630-584-8391
Mailing Address - Fax:630-524-9018
Practice Address - Street 1:1710 N RANDALL RD
Practice Address - Street 2:SUITE 230
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-9400
Practice Address - Country:US
Practice Address - Phone:847-931-8575
Practice Address - Fax:847-931-8581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy