| Phoenix Treatment Center Inc | |
|
4114 1st Ave Nitro WV 25143-1304 | |
| (304) 755-0119 | |
| Not Available |
| Full Name | Phoenix Treatment Center Inc |
|---|---|
| Speciality | Family Medicine - Adolescent Medicine |
| Location | 4114 1st Ave, Nitro, West Virginia |
| Authorized Official Name and Position | Mohammad Kalou (OWNER) |
| Authorized Official Contact | 3046887027 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Treatment Center Inc Po Box 11908 Charleston WV 25339-1908 Ph: () - | Phoenix Treatment Center Inc 4114 1st Ave Nitro WV 25143-1304 Ph: (304) 755-0119 |
| NPI Number | 1699440263 |
|---|---|
| Provider Enumeration Date | 08/15/2021 |
| Last Update Date | 08/15/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699440263 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0000X | Family Medicine - Adolescent Medicine | (* (Not Available)) | Primary |
G. Mark Moreland M.d. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2206 22nd St, Nitro, WV 25143 Phone: 304-755-1571 Fax: 304-755-3091 | |
Nitro Primary Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4111 1st Ave, Nitro, WV 25143 Phone: 304-755-4797 | |
Modern Medicine Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4114 1st Ave, Nitro, WV 25143 Phone: 304-755-0119 Fax: 304-755-0111 |