Healthcare Provider Details

I. General information

NPI: 1528134194
Provider Name (Legal Business Name): WATAUGA MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
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
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: 828-262-4103
Mailing address:
  • Phone: 828-262-4133
  • Fax: 828-262-4103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH0077
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberH0077
License Number StateNC
# 4
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