Organization
TUG RIVER HEALTH ASSOCIATION, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIM CROFTON MBA (EXECUTIVE DIRECTOR)
(304) 448-2101
Entity
Organization
Contact information
Practice address
ROUTE 103 SUPPLY ST., GARY, WV 24836
(304) 448-2101
(304) 448-3217
Mailing address
ROUTE 103 SUPPLY ST., 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)
031000
WV
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6705101000
—
WV
Enumeration date
10/30/2006
Last updated
02/28/2019
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