Provider Demographics
NPI:1518014778
Name:FOX VALLEY IMAGING CENTER, INC.
Entity Type:Organization
Organization Name:FOX VALLEY IMAGING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAGHFAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-416-1300
Mailing Address - Street 1:1971 GOWDEY RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-4232
Mailing Address - Country:US
Mailing Address - Phone:630-416-1300
Mailing Address - Fax:630-416-1511
Practice Address - Street 1:1971 GOWDEY RD
Practice Address - Street 2:SUITE 107
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-4232
Practice Address - Country:US
Practice Address - Phone:630-416-1300
Practice Address - Fax:630-416-1511
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAYLOR MEDICAL DIAGNOSTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-03
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL9251598261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology