Organization
NEW PHOENIX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES EUGENE FOSTER JR. M.D. (OWNER/PRESIDENT)
(937) 299-8242
Entity
Organization
Contact information
Practice address
3533 SOUTHERN BLVD, STE 3000, KETTERING, OH 45429-1280
(937) 299-8242
(937) 299-8245
Mailing address
11161 ASHBURY MEADOWS DR, DAYTON, OH 45458-6403
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H027071
MEDICARE PTAN
OH
Enumeration date
09/20/2011
Last updated
01/19/2018
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