TUG RIVER HEALTH ASSOCIATION, INC (NPI# 1174501068) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174501068 |
| Entity Type | Organization |
| Organization Name | TUG RIVER HEALTH ASSOCIATION, INC |
| Practice Address |
Us Rt 52 Main Street Gary WV 24836 |
| Mailing Address |
Route 103, Supply St. Pob 507 Gary WV 24836 |
| Practice Telephone | 3044482101 |
| Practice Fax Number | 3044483217 |
| Mailing Telephone | 3044482101 |
| Mailing Fax Number | 3044483217 |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2019-09-10 |
| Authorized Official Name | MRS. KIM HARRIS (CREDENTIALING COORDINATOR) |
| Authorized Official Telephone | 3044482101 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
031000 | WV | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WV | RR MEDICARE GROUP # | CN3563 | 01 |
| WV | BCBS | 001706659 | 01 |
| WV | 0035211000 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407922891 | Tug River Health Association, Inc | Clinic/Center | Us Route 103 Supply St, Gary, WV 24836 | 2006-11-28 |
| 1013093350 | Tug River Health Association, Inc | Clinic/Center | 950 Mount View Rd, Suite 500, Welch, WV 24801-2810 | 2006-10-30 |
| 1922184266 | Tug River Health Association, Inc | Clinic/Center | Route 103 Supply St., Gary, WV 24836 | 2006-10-30 |
| 1831275171 | Tug River Health Association, Inc | Clinic/Center | Route 103 Supply St., Gary, WV 24836 | 2006-10-30 |
| 1831273945 | Tug River Health Association, Inc | Clinic/Center | 10 Main Street, Northfork, WV 24868 | 2006-10-25 |
| 1992889000 | Tug River Health Association, Inc | Clinic/Center | 10 Main Street, Northfork, WV 24868 | 2006-10-25 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | TUG RIVER HEALTH ASSOCIATION, INC | Rt 103 Supply St, Gary, WV 24836-0507 |
| Street Address |
US RT 52 MAIN STREET |
| City | GARY |
| State | WV |
| Zip Code | 24836 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730725292 | Tracey L Lester | Family Medicine | 103 Supply Street, Gary, WV 24836 | 2019-11-20 |
| 1912556507 | Tamera Beth Ball | Nurse Practitioner | 150 Venus Drive, Gary, WV 24836 | 2019-09-06 |
| 1366674541 | Veronica Marie Brown | Dentist | Rt. 103 Supply Street, Gary, WV 24836 | 2009-08-20 |
| 1558528554 | Cristie D Hatfield | Dental Hygienist | Route 103 Supply St, Gary, WV 24836 | 2008-05-19 |
| 1548382435 | Tug River Health Association | Clinic/Center | Rt 103 Supply St, Gary, WV 24836 | 2007-04-04 |
| 1407922891 | Tug River Health Association, Inc | Clinic/Center | Us Route 103 Supply St, Gary, WV 24836 | 2006-11-28 |
| 1922184266 | Tug River Health Association, Inc | Clinic/Center | Route 103 Supply St., Gary, WV 24836 | 2006-10-30 |
| 1992887392 | John W Balaban | Dentist | Route 103, Supply St, Gary, WV 24836 | 2006-10-19 |
| 1245286137 | David R Carr | Family Medicine | Route 103 Supply Street, Gary, WV 24836 | 2006-05-25 |
| 1609427350 | Jessica Robin Marcus | Nurse Practitioner | Rr 103 Supply Street, Gary, WV 24836 | 2019-09-24 |
| Find all providers in zip 24836 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| 1003371220 | Porter Starke Services Inc | Clinic/Center | Marram Health Center, 3229 Broadway Suite 160, Gary, IN 46409-1040 | 2019-02-01 |
| 1891262762 | Community Healthnet Inc | Clinic/Center | 3503 Martin Luther King Drive, Community Healthnet Inc - East, Gary, IN 46409-1233 | 2018-10-30 |
| 1023485356 | Porter-starke Services Inc. | Clinic/Center | 3229 Broadway Ste 115, Gary, IN 46409-1040 | 2015-08-21 |
| 1548382435 | Tug River Health Association | Clinic/Center | Rt 103 Supply St, Gary, WV 24836 | 2007-04-04 |
| 1922184266 | Tug River Health Association, Inc | Clinic/Center | Route 103 Supply St., Gary, WV 24836 | 2006-10-30 |
| 1407457591 | Edgewater Systems for Balanced Living, Inc | Clinic/Center | 3535 Broadway, Gary, IN 46409-1316 | 2020-11-04 |
| 1598316978 | Edgewater Systems for Balanced Living, Inc | Clinic/Center | 1100 W 6th Ave, Gary, IN 46402-1711 | 2019-09-26 |
| 1639578065 | Tug River Health Association, Inc. | Clinic/Center | Rr 103 Supply Street, Gary, WV 24836-0507 | 2014-08-21 |
| 1497007876 | Community Healthnet | Clinic/Center | 1015 N Shelby St, Gary, IN 46403-1446 | 2012-10-09 |
| Find all providers in GARY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.