1578729638 NPI number — ANKLE AND FOOT CENTER OF FOX VALLEY, LTD.

Table of content: TYE ED BARBER D.O. (NPI 1275795486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578729638 NPI number — ANKLE AND FOOT CENTER OF FOX VALLEY, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANKLE AND FOOT CENTER OF FOX VALLEY, LTD.
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:
1578729638
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
620 N. RIVER RD.
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60563-8951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-778-7670
Provider Business Mailing Address Fax Number:
630-778-7671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 N. RIVER RD.
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60563-8951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-778-7670
Provider Business Practice Location Address Fax Number:
630-778-7671
Provider Enumeration Date:
07/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JAGODZINSKI
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
OWNER/PODIATRIST
Authorized Official Telephone Number:
630-778-7670

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  016004352 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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