Healthcare Provider Details

I. General information

NPI: 1457464745
Provider Name (Legal Business Name): WATAUGA MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
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: 828-262-4157
Mailing address:
  • Phone: 828-262-4100
  • Fax: 828-262-4157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. RAYANNA M MOORE
Title or Position: SYSTEM DIRECTOR REVENUE CYCLE
Credential:
Phone: 282-262-9110