Provider Demographics
NPI:1609327915
Name:WATAUGA DUFFIELD MEDICAL CENTER, P.C.
Entity Type:Organization
Organization Name:WATAUGA DUFFIELD MEDICAL CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:C
Authorized Official - Last Name:LINKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-631-0432
Mailing Address - Street 1:198 ROSS CARTER BLVD
Mailing Address - Street 2:
Mailing Address - City:DUFFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24244-5117
Mailing Address - Country:US
Mailing Address - Phone:276-431-2900
Mailing Address - Fax:276-431-2904
Practice Address - Street 1:198 ROSS CARTER BLVD
Practice Address - Street 2:
Practice Address - City:DUFFIELD
Practice Address - State:VA
Practice Address - Zip Code:24244-5117
Practice Address - Country:US
Practice Address - Phone:276-431-2900
Practice Address - Fax:276-431-2904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041174207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty