Healthcare Provider Details

I. General information

NPI: 1316013733
Provider Name (Legal Business Name): WATAUGA MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 DEERFIELD RD
BOONE NC
28607-5008
US

IV. Provider business mailing address

155 FURMAN RD SUITE 5
BOONE NC
28607-5049
US

V. Phone/Fax

Practice location:
  • Phone: 828-262-4100
  • Fax: 828-262-4103
Mailing address:
  • Phone: 828-262-4133
  • Fax: 828-262-4103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberH0077
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH0077
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberH0077
License Number StateNC

VIII. Authorized Official

Name: MRS. MARY ETTA LONG
Title or Position: SR VP MEDICAL STAFF SERVICES
Credential: RHIA-CPMSM
Phone: 828-262-4133