Healthcare Provider Details

I. General information

NPI: 1285694125
Provider Name (Legal Business Name): TUG VALLEY DIGESTIVE DISORDER CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 LOGAN ST STE 42
WILLIAMSON WV
25661
US

IV. Provider business mailing address

215 LOGAN ST STE 42
WILLIAMSON WV
41514
US

V. Phone/Fax

Practice location:
  • Phone: 304-235-3590
  • Fax: 304-235-3592
Mailing address:
  • Phone: 304-235-3590
  • Fax: 304-235-3592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number34274
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number19129
License Number StateWV

VIII. Authorized Official

Name: GEORGE A CORTAS
Title or Position: MD OWNER OF PRACTICE
Credential: MDS RACC
Phone: 304-235-3590