Provider Demographics
NPI:1205949732
Name:WATAUGA ANESTHESIA ASSOCIATES, PA
Entity type:Organization
Organization Name:WATAUGA ANESTHESIA ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAL
Authorized Official - Middle Name:E
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-264-4691
Mailing Address - Street 1:PO BOX 2270
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-2270
Mailing Address - Country:US
Mailing Address - Phone:828-264-4691
Mailing Address - Fax:828-265-4288
Practice Address - Street 1:719A GREENWAY ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-2270
Practice Address - Country:US
Practice Address - Phone:828-264-4691
Practice Address - Fax:828-265-4288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902919Medicaid
NC0458Medicare ID - Type Unspecified