Provider Demographics
NPI:1851326797
Name:FOX VALLEY EAR, NOSE AND THROAT, ASSOC., S.C.
Entity Type:Organization
Organization Name:FOX VALLEY EAR, NOSE AND THROAT, ASSOC., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:HEMMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-377-5000
Mailing Address - Street 1:2210 DEAN ST
Mailing Address - Street 2:SUITE L
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-1066
Mailing Address - Country:US
Mailing Address - Phone:630-377-5000
Mailing Address - Fax:630-377-5028
Practice Address - Street 1:2210 DEAN ST
Practice Address - Street 2:SUITE L
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-1066
Practice Address - Country:US
Practice Address - Phone:630-377-5000
Practice Address - Fax:630-377-5028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCF4185OtherMEDICARE RAILROAD PTAN
IL705700Medicare PIN
IL490790Medicare PIN
IL705710Medicare PIN