Basic Information
| Provider Information | |||||||||
| NPI: | 1336323062 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FOX VALLEY PAIN CENTER S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1710 N RANDALL RD | ||||||||
| Address2: | SUITE 370 | ||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601239400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305848391 | ||||||||
| FaxNumber: | 6305249018 | ||||||||
| Practice Location | |||||||||
| Address1: | 1710 N RANDALL RD | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601239400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479318575 | ||||||||
| FaxNumber: | 8479318581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2007 | ||||||||
| LastUpdateDate: | 06/13/2008 | ||||||||
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| AuthorizedOfficialLastName: | CHERALA | ||||||||
| AuthorizedOfficialFirstName: | MURTHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANGER | ||||||||
| AuthorizedOfficialTelephone: | 6305848391 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.