Phoenix Treatment Center Inc

Primary specialty

Adolescent Medicine (Family Medicine) PhysicianTaxonomy code 207QA0000X

Legal business name

PHOENIX TREATMENT CENTER INC

Practice address

4114 1St Ave
Nitro, WV 25143-1304

Phone

(304) 755-0119

NPI assigned

Aug 15, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mohammad Kalou, MD

Title

Owner

Phone

(304) 688-7027

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mohamad Samah Kalou, MD

  • Addiction Medicine (Family Medicine) Physician
  • Charleston, WV
  • NPI 1619065190

  Multi-Specialty

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1628985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628985600000",
    "number": "1699440263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11908",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253391908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4114 1ST AVE",
            "city": "NITRO",
            "state": "WV",
            "postal_code": "251431304",
            "telephone_number": "304-755-0119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX TREATMENT CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-15",
        "last_updated": "2021-08-15",
        "certification_date": "2021-08-15",
        "status": "A",
        "authorized_official_last_name": "KALOU",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-688-7027",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QA0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nitro Primary Care
• Jennifer H Nunley, RN,MSN,FNP-BC
• Peoplework Solutions, Inc.
• Karlie Perkins
• Anne Haley Phipps, APRN, FNP-BC
• Natalie Pitterson, RN
• Planting Seeds Behavioral Health LLC
• Patrick Pontier
• Madison Sharee Potter
• Teressa Amber Vallie Pritt

• All providers in Nitro, WV
• Adolescent Medicine (Family Medicine) Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.