NPIMap

Organization Active NPI

Tug River Health Association, Inc

  • Federally Qualified Health Center (FQHC)
  • Welch, WV
National Provider Identifier
1013093350
Registry record updated Dec 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
031000 Issued in WV
Legal business name
TUG RIVER HEALTH ASSOCIATION, INC
Practice address
950 Mount View Rd
Suite 500
Welch, WV 24801-2810
Phone
(304) 436-4798
Fax
(304) 436-4815
NPI assigned
Oct 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Kim Harris
Title
Credentialing Coordinator
Phone
(304) 448-2101

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 031000 WV Primary

Addresses

Primary practice location

950 Mount View Rd
Suite 500
Welch, WV 24801-2810

Mailing address

Route 103 Supply Street,
PO Box 507
Gary, WV 24836
Phone (304) 448-2101

Other identifiers 2

IdentifierTypeStateIssuer
CN3563OtherWVRR MEDICARE
3810005540MedicaidWV

Other names 1

  • Mount View Tug River Wellness Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051108000741 WV Part A Provider - Federally Qualified Health Center (FQHC) 7214820547 Practice locations: Welch, WV

Federally qualified health center certification: CCN 511901

Legal name
TUG RIVER HEALTH ASSOCIATION, INC
Doing business as
TUG RIVER/MOUNT VIEW WELLNESS CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 22, 2005
Last certification
Nov 22, 2005
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Mar 19, 1975 in WV
Enrollment address
950 Mount View Rd
# 500
Welch, WV 24801-2810

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Andrea Thornton Individual Corporate DirectorCeo Jan 1, 2023
W-2 Managing EmployeeCeo Jan 1, 2023
David Dunson Individual Corporate OfficerBoard Member Jul 1, 2000
Corporate Director Sep 16, 2009
Micheal Lushbaugh Individual Corporate OfficerBoard Member Jul 1, 2000
Lana Kibbey Individual Corporate OfficerBoard Member Jul 1, 2006
Mark Jones Individual Corporate Officer Jul 1, 2006
Clara L Thompson Individual Corporate OfficerBoard Member Jul 1, 2006

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Tug River Riverview Wellness CenterBradshaw, WV, CCN 511973 Federally qualified health center Operational/Managerial Control Mar 1, 2011
Tug River Health Association, IncPrinceton, WV, CCN 581808 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 1, 2000

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544054400000",
    "number": "1013093350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ROUTE 103 SUPPLY STREET,",
            "address_2": "PO BOX 507",
            "city": "GARY",
            "state": "WV",
            "postal_code": "24836",
            "telephone_number": "304-448-2101",
            "fax_number": "304-448-3217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 MOUNT VIEW RD",
            "address_2": "SUITE 500",
            "city": "WELCH",
            "state": "WV",
            "postal_code": "248012810",
            "telephone_number": "304-436-4798",
            "fax_number": "304-436-4815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TUG RIVER HEALTH ASSOCIATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-30",
        "last_updated": "2018-12-06",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "304-448-2101",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WV",
            "license": "031000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CN3563",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810005540",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mount View Tug River Wellness Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Mount View Tug River Wellness Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Welch, WV

Sources for this page

Verify at the official NPI Registry.