MEDICARE: WATAUGA PATHOLOGY ASSOCIATES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory		TN

General Provider Information

NPI Number	:	1174820971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WATAUGA PATHOLOGY ASSOCIATES PC

Provider Business Mailing Address
First Line	:	1725 W MARKET ST
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-6020
Country	:	US
Telephone Number	:	423-431-1310
Fax Number	:	423-431-6331

Provider Business Practice Location Address
First Line	:	1725 W MARKET ST
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-6020
Country	:	US
Telephone Number	:	423-431-1310
Fax Number	:	423-431-6331

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID SOIKE
Credential	:	MD
Telephone Number	:	423-431-1310

Provider Enumeration Date	:	02/15/2011
Last Update Date	:	02/15/2011

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