MEDICARE: TUG VALLEY DIGESTIVE DISORDER CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	34274	KY
2	207RG0100X	Gastroenterology Physician	19129	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285694125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUG VALLEY DIGESTIVE DISORDER CENTER INC

Provider Business Mailing Address
First Line	:	215 LOGAN ST
Second Line	:	STE 42
City	:	WILLIAMSON
State	:	WV
Zip	:	41514
Country	:	US
Telephone Number	:	304-235-3590
Fax Number	:	304-235-3592

Provider Business Practice Location Address
First Line	:	215 LOGAN ST
Second Line	:	STE 42
City	:	WILLIAMSON
State	:	WV
Zip	:	25661
Country	:	US
Telephone Number	:	304-235-3590
Fax Number	:	304-235-3592

Authorized Official
Title or Position	:	MD OWNER OF PRACTICE
Name	:	GEORGE A CORTAS
Credential	:	MDS RACC
Telephone Number	:	304-235-3590

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	08/22/2020

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