Healthcare Provider Details

I. General information

NPI: 1205859766
Provider Name (Legal Business Name): WATAUGA MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
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 101
BOONE NC
28607-5049
US

V. Phone/Fax

Practice location:
  • Phone: 828-262-4100
  • Fax: 828-262-4157
Mailing address:
  • Phone: 828-262-4438
  • Fax: 828-262-4157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License NumberH0037
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY ETTA LONG
Title or Position: SR VP MEDICAL STAFF RELATIONS
Credential:
Phone: 828-262-4133