Organization
FOX VALLEY HEMATOLOGY & ONCOLOGY, S.C.
Active
Parent organization
FOX VALLEY HEMATOLOGY & ONCOLOGY, S.C.
Organization subpart
Yes
Provider details
NPI number
Legal business name
FOX VALLEY HEMATOLOGY & ONCOLOGY, S.C.
Authorized official
TIMOTHY F GOGGINS M.D. (CHIEF MEDICAL OFFICER/PHYSICIAN)
(920) 749-1171
Entity
Organization
Contact information
Practice address
1415 E GREEN BAY ST, SUITE 141, SHAWANO, WI 54166-3879
(715) 201-6599
Mailing address
3232 N BALLARD RD, SUITE 200, APPLETON, WI 54911-8804
(920) 749-1171
(920) 734-5307
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0886830003
DME MAC
WI
05
—
32802700
—
WI
Enumeration date
04/11/2007
Last updated
02/03/2017
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