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General NPI Number Information
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NPI Number | 1528134194
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Entity Type | Organization
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Legal Business Name | WATAUGA MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 336 DEERFIELD RD
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City | BOONE
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State | NC
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Zip | 28607
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Country | US
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Telephone | 828-262-4100
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Fax | 828-262-4103
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Provider Business Mailing Address
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Address Line | 155 FURMAN RD SUITE 101
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City | BOONE
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State | NC
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Zip | 28607-5049
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Country | US
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Telephone | 828-262-4133
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Fax | 828-262-4103
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Authorized Official
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Title or Position | SR VP MEDICAL STAFF SERVICES
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Name | MRS. MARY ETTA LONG
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Credential | RHIA-CPMSM
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Telephone | 828-262-4133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | H0077
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2084S0012X
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Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | H0077
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | H0077
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License Number State | NC
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