Provider Demographics
NPI:1407868334
Name:FOX VALLEY HEMATOLOGY & ONCOLOGY, S.C.
Entity Type:Organization
Organization Name:FOX VALLEY HEMATOLOGY & ONCOLOGY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:F
Authorized Official - Last Name:GOGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-749-1171
Mailing Address - Street 1:3232 N BALLARD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-8804
Mailing Address - Country:US
Mailing Address - Phone:920-749-9668
Mailing Address - Fax:920-734-5307
Practice Address - Street 1:3925 N GATEWAY DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-7863
Practice Address - Country:US
Practice Address - Phone:920-749-1171
Practice Address - Fax:920-749-1172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
WI207RH0003X, 293D00000X, 332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Multi-Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32802700Medicaid
=========013OtherBCBS
WI0886830001Medicare NSC
WI71005Medicare ID - Type Unspecified
=========013OtherBCBS
WIK300307094Medicare PIN