1487982229 NPI number — FOX VALLEY HEMATOLOGY INC

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 1487982229 NPI number — FOX VALLEY HEMATOLOGY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOX VALLEY HEMATOLOGY INC
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:
1487982229
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1710 N RANDALL RD
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
ELGIN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60123-9400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-931-0909
Provider Business Mailing Address Fax Number:
847-931-0939

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10350 HALIGUS RD
Provider Second Line Business Practice Location Address:
STE 210
Provider Business Practice Location Address City Name:
HUNTLEY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60142-9545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-802-7880
Provider Business Practice Location Address Fax Number:
847-931-0939
Provider Enumeration Date:
12/04/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SCALETTA
Authorized Official First Name:
BEVERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
847-931-0909

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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