Healthcare Provider Details

I. General information

NPI: 1265068027
Provider Name (Legal Business Name): WATAUGA MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2020
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

PO BOX 2600
BOONE NC
28607-2600
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY ETTA LONG
Title or Position: SVP
Credential:
Phone: 828-262-4133