Provider Demographics
NPI:1104943786
Name:FOX RIVER FOOT & ANKLE CENTER PC
Entity type:Organization
Organization Name:FOX RIVER FOOT & ANKLE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:815-634-2324
Mailing Address - Street 1:810 E DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:COAL CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60416-1338
Mailing Address - Country:US
Mailing Address - Phone:815-634-2324
Mailing Address - Fax:815-634-2343
Practice Address - Street 1:810 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:COAL CITY
Practice Address - State:IL
Practice Address - Zip Code:60416-1338
Practice Address - Country:US
Practice Address - Phone:815-634-2324
Practice Address - Fax:815-634-2343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2022-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004700332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK04515OtherMEDICARE MEMBER #
IL1089540001Medicare NSC
ILK04515OtherMEDICARE MEMBER #