Organization
TUG RIVER HEALTH ASSOCIATION, INC.
Active
Other names
Pineville Childrens Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KIM HARRIS (CREDENTIALING /BILLING COORD.)
(304) 448-2101
Entity
Organization
Contact information
Practice address
585 APPALACHIAN HIGHWAY, PINEVILLE, WV 24817
(304) 732-7069
Mailing address
RR 103 SUPPLY STREET, GARY, WV 24836
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
51D0233700
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810014476
—
WV
Enumeration date
08/07/2018
Last updated
08/07/2018
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