Provider Demographics
NPI:1649716358
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:OFFICER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:GUENTHER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:920-749-1171
Mailing Address - Street 1:3232 N BALLARD RD
Mailing Address - Street 2:SUITE 200
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 1:1716 LAWRENCE DR
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-9108
Practice Address - Country:US
Practice Address - Phone:920-749-1171
Practice Address - Fax:920-734-5307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000045450OtherPTAN
WI32802700Medicaid