NPIMap

Organization Active NPI

Tug River Health Association, Inc

  • Federally Qualified Health Center (FQHC)
  • Northfork, WV
National Provider Identifier
1831273945
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
10 Main Street
Northfork, WV 24868
Phone
(304) 862-2588
Fax
(304) 862-2244
NPI assigned
Oct 25, 2006
Last updated
Dec 6, 2018By the provider in NPPES
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

10 Main Street
Northfork, WV 24868

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
CN3563OtherWVRR MEDICARE
001706659OtherWVMS BCBS
0035035000MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051010000216 WV Part B Supplier - Public Health/Welfare Agency 7214820547 Receives reassigned benefits from 30 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gary, WV; Northfork, WV; Pineville, WV
O20101110000239 WV Part A Provider - Federally Qualified Health Center (FQHC) 7214820547 Practice locations: Northfork, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831273945. Details of each certification follow.

Federally qualified health center certification: CCN 511818

Legal name
TUG RIVER HEALTH ASSOCIATION, INC
Doing business as
TUG RIVER HEALTH ASSOCIATION, INC (NORTHFORK)
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 1976 in WV
Enrollment address
34035 Coal Heritage Rd
Northfork, WV 24868

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
51D0233693Tug River Health Association Inc34035 Coal Heritage Rd, Northfork, WV 24868Certificate of waiverOct 20, 2026

National Provider Directory

National Provider Directory
Tax ID family
Tug River Health Association Inc15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Ownership & related parties

All disclosed owners & managing parties 7

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 5% Or Greater Direct Ownership Interest Jan 1, 2023 100%
W-2 Managing Employee Jan 1, 2023
David Dunson Individual Corporate Director Nov 1, 2010
Margaret Fontana Individual W-2 Managing Employee Jan 1, 2014
Micheal Lushbaugh Individual Corporate Director Nov 1, 2010
Lana Kibbey Individual Corporate Director Nov 1, 2010
Clara L Thompson Individual Corporate Director Nov 1, 2010
John Calloway Individual Corporate Director Nov 1, 2010

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.

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544054400000",
    "number": "1831273945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ROUTE 103 SUPPLY STREET, 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": "10 MAIN STREET",
            "city": "NORTHFORK",
            "state": "WV",
            "postal_code": "24868",
            "telephone_number": "304-862-2588",
            "fax_number": "304-862-2244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TUG RIVER HEALTH ASSOCIATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "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": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MS BCBS",
            "identifier": "001706659",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0035035000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Northfork, WV

Sources for this page

Verify at the official NPI Registry.