Healthcare Provider Details

I. General information

NPI: 1275527863
Provider Name (Legal Business Name): WATAUGA MEDICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 W KING ST
BOONE NC
28607-3468
US

IV. Provider business mailing address

921 W KING ST
BOONE NC
28607-3468
US

V. Phone/Fax

Practice location:
  • Phone: 828-264-9486
  • Fax: 828-264-9482
Mailing address:
  • Phone: 828-264-9486
  • Fax: 828-264-9482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number0951125
License Number StateNC

VIII. Authorized Official

Name: MR. CRAIG J SULLLIVAN
Title or Position: DIRECTOR OWNER
Credential:
Phone: 828-264-9486