Provider Demographics
NPI:1265590848
Name:FOX VALLEY PULMONARY MEDICINE, LLC
Entity type:Organization
Organization Name:FOX VALLEY PULMONARY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PLOEDERL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-380-1535
Mailing Address - Street 1:820 E GRANT ST
Mailing Address - Street 2:SUITE S250
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-3483
Mailing Address - Country:US
Mailing Address - Phone:920-734-9600
Mailing Address - Fax:920-734-4773
Practice Address - Street 1:820 E GRANT ST
Practice Address - Street 2:SUITE S 250
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-3483
Practice Address - Country:US
Practice Address - Phone:920-734-9600
Practice Address - Fax:920-734-4773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32879600Medicaid
WI38205Medicare ID - Type Unspecified2NDMEDICARE GROUP NUMBER
WI32879600Medicaid