Provider Demographics
NPI:1861597627
Name:FOX RIVER AMBULATORY OUTPATIENT, INC
Entity type:Organization
Organization Name:FOX RIVER AMBULATORY OUTPATIENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-551-3338
Mailing Address - Street 1:5786 DANIELLE LN
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-9179
Mailing Address - Country:US
Mailing Address - Phone:815-634-2324
Mailing Address - Fax:815-634-2343
Practice Address - Street 1:3963 US HIGHWAY 34
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8950
Practice Address - Country:US
Practice Address - Phone:630-551-3338
Practice Address - Fax:630-551-4117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies