Provider Demographics
NPI:1477539443
Name:RADIOLOGY ASSOCIATES OF THE FOX VALLEY, SC
Entity Type:Organization
Organization Name:RADIOLOGY ASSOCIATES OF THE FOX VALLEY, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GARAFALO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-722-1583
Mailing Address - Street 1:333 N COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2657
Mailing Address - Country:US
Mailing Address - Phone:920-722-1583
Mailing Address - Fax:920-722-7454
Practice Address - Street 1:333 N COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2657
Practice Address - Country:US
Practice Address - Phone:920-722-1583
Practice Address - Fax:920-722-7454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32728300Medicaid
WI000069060Medicare ID - Type Unspecified
000071271Medicare PIN
WI32728300Medicaid
000069060Medicare PIN