Healthcare Provider Details

I. General information

NPI: 1881085587
Provider Name (Legal Business Name): WATAUGA MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 A BOONE HEIGHTS DRRIVE
BOONE NC
28607
US

IV. Provider business mailing address

232A BOONE HEIGHTS DR
BOONE NC
28607-4926
US

V. Phone/Fax

Practice location:
  • Phone: 828-268-9043
  • Fax: 828-268-9045
Mailing address:
  • Phone: 828-268-9043
  • Fax: 828-268-9045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. TAMMY LYNN MOODY
Title or Position: PROVIDER ENROLLMENT SPECIALIST
Credential:
Phone: 828-263-1211