Organization
TUG RIVER HEALTH ASSOCIATION
Active
Organization
TUG RIVER HEALTH ASSOCIATION
Active
Other names
Pineville Children's Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIM HARRIS (BILLING SUPERVISOR)
(304) 448-2101
Entity
Organization
Contact information
Practice address
US ROUTE 10, PINEVILLE, WV 24874-0430
(304) 732-7069
(304) 732-7098
Mailing address
PO BOX 507, GARY, WV 24836-0507
(304) 448-2101
(304) 448-3217
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51D0233700
CLIA CERT #
WV
Enumeration date
11/21/2008
Last updated
11/21/2008
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