Organization
TUG RIVER HEALTH ASSOCIATION, INC
Active
Other names
Mount View Tug River Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIM HARRIS (CREDENTIALING COORDINATOR)
(304) 448-2101
Entity
Organization
Contact information
Practice address
950 MOUNT VIEW RD, SUITE 500, WELCH, WV 24801-2810
(304) 436-4798
(304) 436-4815
Mailing address
ROUTE 103 SUPPLY STREET,, PO BOX 507, GARY, WV 24836
(304) 448-2101
(304) 448-3217
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
031000
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810005540
—
WV
01
—
CN3563
RR MEDICARE
WV
Enumeration date
10/30/2006
Last updated
12/06/2018
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