1134585508 NPI number — ANESTHESIA SERVICES OF THE FOX VALLEY, S.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134585508 NPI number — ANESTHESIA SERVICES OF THE FOX VALLEY, S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANESTHESIA SERVICES OF THE FOX VALLEY, S.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134585508
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
926 ROOSEVELT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAUKAUNA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54130-1660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-716-3272
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 S OAKWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSHKOSH
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54904-7944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-223-1941
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
NIGL
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
920-223-1941

Provider Taxonomy Codes

  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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