Organization
TUG RIVER HEALTH ASSOCIATION, INC
Active
Other names
Pineville Children's Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIM HARRIS (CREDENTIALING COORDINATOR)
(304) 448-2101
Entity
Organization
Contact information
Practice address
US ROUTE 103 SUPPLY ST, GARY, WV 24836
(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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810014476
—
WV
Enumeration date
11/28/2006
Last updated
08/03/2021
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