Provider Demographics
NPI:1124241724
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:CHIEF MEDICAL OFFICER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:F
Authorized Official - Last Name:GOGGINS
Authorized Official - Suffix:
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:920-749-1171
Mailing Address - Fax:920-734-5307
Practice Address - Street 1:1415 E GREEN BAY ST
Practice Address - Street 2:SUITE 141
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-3879
Practice Address - Country:US
Practice Address - Phone:715-201-6599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOX VALLEY HEMATOLOGY & ONCOLOGY, S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-11
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0886830003OtherDME MAC
WI32802700Medicaid
WI32802700Medicaid
WI32802700Medicaid
WI=========013OtherBCBS