Tug River Health Association, Inc.
Organization Active NPI Clinical Medical Laboratory · Bradshaw, WV
NPI 1720567241 · NPPES record last updated Aug 7, 2018
Key facts
- NPI
- 1720567241
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Medical Laboratory 291U00000X
- License
- 51D1064007 (WV)
- Legal business name
- TUG RIVER HEALTH ASSOCIATION, INC.
- Practice address
- 512 Mountaineeer Highway
Room 1344
Bradshaw, WV 24874-2487 - Phone
- (304) 967-7684
- NPI assigned
- Aug 7, 2018
- Organization subpart
- No
Authorized official
- Name
- Kim Harris
- Title
- Credentialing/Billing Coord.
- Phone
- (304) 448-2101
Corporate family (same tax ID) 14
National Provider Directory
- Tax ID family
- Tug River Health Association Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | 51D1064007 | WV | Yes |
Addresses
Primary practice location
512 Mountaineeer Highway
Room 1344
Bradshaw, WV 24874-2487
Mailing address
RR 103 Supply Street
PO Box 507
Gary, WV 24836
Phone (304) 448-2101
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810021840 | Medicaid | WV |
Other names
- Tug River/Riverview Wellness Center
Other providers in Bradshaw, WV
- Mahesh B Patel
- Abigail Jaiden Lerea Pruitt
- Lisa Ann Remines
- Angguna R Rowe
- Tug River Health Association, Inc.
- Cherie L Vance
- Marlene Vance
- Walgreen Co
All providers in Bradshaw, WV · Clinical Medical Laboratory in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 7, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.