Organization
TUG RIVER HEALTH ASSOCIATION, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHARI AGNEW (CREDENTIALING COORDINATOR)
(304) 862-2588
Entity
Organization
Contact information
Practice address
US RT 52 MAIN STREET, GARY, WV 24836
(304) 448-2101
(304) 448-3217
Mailing address
ROUTE 103, SUPPLY ST., POB 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
01
—
001706659
BCBS
WV
05
—
0035211000
—
WV
01
—
CN3563
RR MEDICARE GROUP #
WV
Enumeration date
01/03/2006
Last updated
04/08/2022
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