Organization
FOX VALLEY DIALYSIS LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CALVIN GANONG (CHIEF OPERATING OFFICER)
(630) 851-1206
Entity
Organization
Contact information
Practice address
1300 WATERFORD DR, AURORA, IL 60504-5502
(630) 236-1300
Mailing address
1300 WATERFORD DR, LOWR LEVEL, AURORA, IL 60504-5502
(630) 851-1206
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
644
BLUE CROSS PROVIDER NUMBE
IL
Enumeration date
05/23/2005
Last updated
08/22/2020
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