NPIMap

Organization Active NPI

Tug River Health Association, Inc

  • Federally Qualified Health Center (FQHC)
  • Northfork, WV
National Provider Identifier
1992889000
Registry record updated Aug 22, 2020
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
Organization subpart
No

Authorized official

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

Corporate family (same tax ID) 14

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

National Provider Directory

Tax ID family
Tug River Health Association Inc (15 organizations share this tax ID)

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

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 1

NPPES NPI Registry
IdentifierTypeStateIssuer
6705105000MedicaidWV

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1992889000",
    "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": "2020-08-22",
        "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": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6705105000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Northfork, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.