Tug River Health Association, Inc | |
10 Main Street Northfork WV 24868 | |
(304) 862-2588 | |
(304) 862-2244 |
Full Name | Tug River Health Association, Inc |
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Speciality | Clinic/Center |
Location | 10 Main Street, Northfork, West Virginia |
Authorized Official Name and Position | Kim Harris (CREDENTIALING COORDINATOR) |
Authorized Official Contact | 3044482101 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Tug River Health Association, Inc Route 103 Supply Street, Po Box 507 Gary WV 24836 Ph: (304) 448-2101 | Tug River Health Association, Inc 10 Main Street Northfork WV 24868 Ph: (304) 862-2588 |
NPI Number | 1831273945 |
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Provider Enumeration Date | 10/25/2006 |
Last Update Date | 12/06/2018 |
Medicare PECOS PAC ID | 7214820547 |
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Medicare Enrollment ID | O20051010000216 |
Identifier | Type | State | Issuer |
---|---|---|---|
1831273945 | NPI | - | NPPES |
0035035000 | Medicaid | WV | |
001706659 | Other | WV | MS BCBS |
CN3563 | Other | WV | RR MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 031000 (West Virginia) | Primary |
Provider Name | Mohammad Abdullah Ashir |
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Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1104817956 PECOS PAC ID: 8022901594 Enrollment ID: I20040206000812 |
Provider Name | Sandra L Estep |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1184705816 PECOS PAC ID: 4880677798 Enrollment ID: I20040611000039 |
Provider Name | Paul M Little |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1144319211 PECOS PAC ID: 5395706006 Enrollment ID: I20041025001022 |
Provider Name | Alice J Roberts |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1487743571 PECOS PAC ID: 0749226256 Enrollment ID: I20050706001096 |
Provider Name | Anthony W Thacker |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1750461190 PECOS PAC ID: 1153368576 Enrollment ID: I20051227000393 |
Provider Name | Teresa Yvonne Thacker |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1891875274 PECOS PAC ID: 4789621103 Enrollment ID: I20110203000307 |
Provider Name | Kari Beth Law |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1295825388 PECOS PAC ID: 9931282191 Enrollment ID: I20120127000651 |
Provider Name | Angela G Mckinney |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1285989152 PECOS PAC ID: 8921257296 Enrollment ID: I20121001000446 |
Provider Name | Keisha Saunders |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1942559364 PECOS PAC ID: 1052560018 Enrollment ID: I20121008000059 |
Provider Name | Rosalind R Berry |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1033534342 PECOS PAC ID: 2163645144 Enrollment ID: I20140520000953 |
Provider Name | Monique S Rash |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1689927691 PECOS PAC ID: 9032362827 Enrollment ID: I20140606000350 |
Provider Name | Joanna Bailey |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1013204734 PECOS PAC ID: 3173743671 Enrollment ID: I20141006000700 |
Provider Name | Julie A Massey |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1639545395 PECOS PAC ID: 9133438823 Enrollment ID: I20151020001967 |
Provider Name | Robin E Riddle |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1619346509 PECOS PAC ID: 4486954401 Enrollment ID: I20151207000798 |
Provider Name | Jennifer Fain |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1679922132 PECOS PAC ID: 8527350578 Enrollment ID: I20160712001029 |
Provider Name | John Randolph Forehand |
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Provider Type | Practitioner - Pulmonary Disease |
Provider Identifiers | NPI Number: 1902888258 PECOS PAC ID: 9436045853 Enrollment ID: I20160912000660 |
Provider Name | Katherine J Steele |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1003251810 PECOS PAC ID: 2668613050 Enrollment ID: I20160923001792 |
Provider Name | Matthew Dellacona |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1881033058 PECOS PAC ID: 0648586552 Enrollment ID: I20170103001031 |
Provider Name | Angelia Michelle Hopkins |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1699130591 PECOS PAC ID: 1355685827 Enrollment ID: I20181211000498 |
Provider Name | Carol Suzanne Dennison |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1255801312 PECOS PAC ID: 3274870787 Enrollment ID: I20190122002493 |
Provider Name | Christa Noel Mcintyre |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1427582568 PECOS PAC ID: 1355670613 Enrollment ID: I20190911002378 |
Provider Name | Jessica Marcus |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1609427350 PECOS PAC ID: 8426483975 Enrollment ID: I20200110002357 |
Provider Name | Tracey L Lester |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1730725292 PECOS PAC ID: 0547697328 Enrollment ID: I20200218001523 |
Provider Name | Julia Blevins |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1255059796 PECOS PAC ID: 5193191740 Enrollment ID: I20221021002209 |
Provider Name | Anthony Shayne Dillon |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1326773334 PECOS PAC ID: 4789069519 Enrollment ID: I20230109000872 |
Provider Name | Amanda Bliss Perry |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1962113621 PECOS PAC ID: 8729429568 Enrollment ID: I20240510003264 |
Tug River Health Association, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 10 Main Street, Northfork, WV 24868 Phone: 304-862-2588 Fax: 304-862-2244 |