Provider Demographics
NPI:1285694125
Name:TUG VALLEY DIGESTIVE DISORDER CENTER INC
Entity type:Organization
Organization Name:TUG VALLEY DIGESTIVE DISORDER CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER OF PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORTAS
Authorized Official - Suffix:
Authorized Official - Credentials:MDS RACC
Authorized Official - Phone:304-235-3590
Mailing Address - Street 1:215 LOGAN ST
Mailing Address - Street 2:STE 42
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:41514
Mailing Address - Country:US
Mailing Address - Phone:304-235-3590
Mailing Address - Fax:304-235-3592
Practice Address - Street 1:215 LOGAN ST
Practice Address - Street 2:STE 42
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661
Practice Address - Country:US
Practice Address - Phone:304-235-3590
Practice Address - Fax:304-235-3592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19129207RG0100X
KY34274207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64942030Medicaid
WV0088462000Medicaid
KY64942030Medicaid
WV0088462000Medicaid