Provider Demographics
NPI:1821376419
Name:FOX VALLEY WELLNESS CENTER/MIDWEST HYPERBARICS
Entity Type:Organization
Organization Name:FOX VALLEY WELLNESS CENTER/MIDWEST HYPERBARICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:MERESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-922-5433
Mailing Address - Street 1:180 KNIGHTS WAY
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-8027
Mailing Address - Country:US
Mailing Address - Phone:920-922-5433
Mailing Address - Fax:920-273-0480
Practice Address - Street 1:180 KNIGHTS WAY
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-8027
Practice Address - Country:US
Practice Address - Phone:920-922-5433
Practice Address - Fax:920-273-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28559174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty