Provider Demographics
NPI:1861031544
Name:WATAUGA MEDICAL CENTER INC
Entity Type:Organization
Organization Name:WATAUGA MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP MEDICAL STAFF RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ETTA
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-262-4133
Mailing Address - Street 1:PO BOX 2600
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-2600
Mailing Address - Country:US
Mailing Address - Phone:828-262-4133
Mailing Address - Fax:828-262-4103
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:828-262-4133
Practice Address - Fax:828-262-4103
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WATAUGA MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty