NPIMap

Organization Active NPI

Tug River Health Association, Inc

  • Clinical Medical Laboratory
  • Gary, WV
National Provider Identifier
1831275171
Registry record updated Feb 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
TUG RIVER HEALTH ASSOCIATION, INC
Practice address
Route 103 Supply St.
Gary, WV 24836
Phone
(304) 448-2101
Fax
(304) 448-3217
NPI assigned
Oct 30, 2006
Last updated
Feb 28, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2019

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

Authorized official

Name
Tim Crofton, MBA
Title
Executive Director
Phone
(304) 448-2101

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 031000 WV
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

Route 103 Supply St.
Gary, WV 24836

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
6705101000MedicaidWV

National Provider Directory

National Provider Directory
Tax ID family
Tug River Clinic15 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

Locations

1051 Stafford Dr
#617
Princeton, WV 24740

327 Mercer St
Princeton, WV 24740
Phone (304) 425-9489

1880 Mount View Rd
#959
Welch, WV 24801

Practitioners & affiliated clinicians

Practitioners 23

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 23

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": "1551312000000",
    "number": "1831275171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ROUTE 103 SUPPLY ST.",
            "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": "ROUTE 103 SUPPLY ST.",
            "city": "GARY",
            "state": "WV",
            "postal_code": "24836",
            "telephone_number": "304-448-2101",
            "fax_number": "304-448-3217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TUG RIVER HEALTH ASSOCIATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-30",
        "last_updated": "2019-02-28",
        "status": "A",
        "authorized_official_last_name": "CROFTON",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "304-448-2101",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WV",
            "license": "031000",
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6705101000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gary, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.