Organization
TUG RIVER HEALTH ASSOCIATION, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIM HARRIS (CREDENTIALING COORDINATOR)
(304) 448-2101
Entity
Organization
Contact information
Practice address
10 MAIN STREET, NORTHFORK, WV 24868
(304) 862-2588
(304) 862-2244
Mailing address
ROUTE 103 SUPPLY STREET, PO BOX 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
MS BCBS
WV
05
—
0035035000
—
WV
01
—
CN3563
RR MEDICARE
WV
Enumeration date
10/25/2006
Last updated
12/06/2018
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