Tug River Health Association | |
200 12th Street Ext Princeton WV 24740-2329 | |
(304) 431-1400 | |
Not Available |
Full Name | Tug River Health Association |
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Speciality | Clinic/Center |
Location | 200 12th Street Ext, Princeton, West Virginia |
Authorized Official Name and Position | Sharon G Agnew (CREDENTIALING SPECIALIST) |
Authorized Official Contact | 3048622588 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Tug River Health Association 200 12th Street Ext Princeton WV 24740-2329 Ph: (304) 431-1400 | Tug River Health Association 200 12th Street Ext Princeton WV 24740-2329 Ph: (304) 431-1400 |
NPI Number | 1639842818 |
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Provider Enumeration Date | 07/26/2021 |
Last Update Date | 03/28/2022 |
Medicare PECOS PAC ID | 7214820547 |
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Medicare Enrollment ID | O20220514000276 |
Identifier | Type | State | Issuer |
---|---|---|---|
1639842818 | NPI | - | NPPES |
1639842818 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Provider Name | Robin E Riddle |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1619346509 PECOS PAC ID: 4486954401 Enrollment ID: I20151207000798 |
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