Provider Demographics
NPI:1942323407
Name:FOX VALLEY HEMATOLOGY & ONCOLOGY, S.C.
Entity Type:Organization
Organization Name:FOX VALLEY HEMATOLOGY & ONCOLOGY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:F
Authorized Official - Last Name:GOGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-749-1171
Mailing Address - Street 1:3232 N BALLARD RD
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-8804
Mailing Address - Country:US
Mailing Address - Phone:920-749-9668
Mailing Address - Fax:920-734-5307
Practice Address - Street 1:491 S WASHBURN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-6733
Practice Address - Country:US
Practice Address - Phone:920-292-5555
Practice Address - Fax:920-292-1717
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOX VALLEY HEMATOLOGY, S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-09
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 207RH0003X
WI332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI08868300006OtherDMEPOS - DMEMAC
WI32802700Medicaid
WI=========013OtherBCBS
WI32802700Medicaid