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General NPI Number Information
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NPI Number | 1831273945
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Entity Type | Organization
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Legal Business Name | TUG RIVER HEALTH ASSOCIATION, INC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 12/06/2018
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Provider Practice Location Address
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Address Line | 10 MAIN STREET
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City | NORTHFORK
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State | WV
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Zip | 24868
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Country | US
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Telephone | 304-862-2588
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Fax | 304-862-2244
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Provider Business Mailing Address
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Address Line | ROUTE 103 SUPPLY STREET, PO BOX 507
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City | GARY
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State | WV
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Zip | 24836
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Country | US
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Telephone | 304-448-2101
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Fax | 304-448-3217
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | MRS. KIM HARRIS
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Credential |
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Telephone | 304-448-2101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 031000
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License Number State | WV
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