Provider Demographics
NPI:1457464745
Name:WATAUGA MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:WATAUGA MEDICAL CENTER, INC
Other - Org Name:WATAUGA MEDICAL CENTER, INC KIDNEY DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SYSTEM DIRECTOR REVENUE CYCLE
Authorized Official - Prefix:MS
Authorized Official - First Name:RAYANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:282-262-9110
Mailing Address - Street 1:155 FURMAN RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5049
Mailing Address - Country:US
Mailing Address - Phone:828-262-4100
Mailing Address - Fax:828-262-4157
Practice Address - Street 1:336 DEERFIELD RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5008
Practice Address - Country:US
Practice Address - Phone:828-262-4100
Practice Address - Fax:828-262-4157
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPALACHIAN REGIONAL HEALTHCARE SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-17
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0054FOtherBCBS
NC342311Medicare PIN