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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