Healthcare Provider Details

I. General information

NPI: 1366379075
Provider Name (Legal Business Name): PHOENIX CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 N 2ND ST
IRONTON OH
45638-1235
US

IV. Provider business mailing address

PO BOX 614
IRONTON OH
45638-0614
US

V. Phone/Fax

Practice location:
  • Phone: 740-442-7045
  • Fax: 740-442-7047
Mailing address:
  • Phone: 740-442-7045
  • Fax: 740-442-7047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: KASEY MCCALLISTER
Title or Position: COMPLIANCE AND RISK DIRECTOR
Credential:
Phone: 740-442-7045