Provider Demographics
NPI:1508071457
Name:FOX VALLEY PHYSICIAN SERVICES SC
Entity Type:Organization
Organization Name:FOX VALLEY PHYSICIAN SERVICES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOER
Authorized Official - Suffix:
Authorized Official - Credentials:DC PAC
Authorized Official - Phone:630-966-2637
Mailing Address - Street 1:23 N LINCOLNWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1635
Mailing Address - Country:US
Mailing Address - Phone:630-966-2637
Mailing Address - Fax:630-966-1611
Practice Address - Street 1:23 N LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1635
Practice Address - Country:US
Practice Address - Phone:630-966-2637
Practice Address - Fax:630-966-1611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4532434OtherBCBS
IL215546Medicare PIN