Watauga Surgical Partners PLLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

WATAUGA SURGICAL PARTNERS PLLC

Practice address

10425 Wallace Alley Street
Kingsport, TN 37663

Phone

(423) 282-9011

Fax

(423) 282-0035

NPI assigned

Dec 15, 2022

Last updated

Dec 15, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kim Marden

Title

Chief Executive Officer

Phone

(423) 282-9011

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN2 enrollments

Enrollment records 2

Listed as

Watauga Surgical Partners Dba Watauga Ortho Center for Advanced Bone and Joint SurgeryCCN 44C0001214

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• David C Carver, MD

  • Orthopaedic Surgery Physician
  • Bristol, TN
  • NPI 1437492907
  NPD (past)
• Nathan Michael Davis, RN

  • Certified Registered Nurse Anesthetist
  • Kingsport, TN
  • NPI 1730375643
  NPD (past)
• Autumn Samantha Longworth, CRNA

  • Certified Registered Nurse Anesthetist
  • Blountville, TN
  • NPI 1386204329
  NPD (past)
• Kent J Lord, M.D.

  • Orthopaedic Surgery Physician
  • Johnson City, TN
  • NPI 1679785935
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1671062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671062400000",
    "number": "1194437624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2410 SUSANNAH STREET",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10425 WALLACE ALLEY STREET",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "37663",
            "telephone_number": "423-282-9011",
            "fax_number": "423-282-0035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATAUGA SURGICAL PARTNERS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-15",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-15",
        "status": "A",
        "authorized_official_last_name": "MARDEN",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "423-282-9011"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Philip Craig Warren, B.S. O.T.
• Adil Kabir Warsy, M.D.
• Craig Wassinger, PT
• Watauga Dental Center, PLLC
• Watauga Orthopaedics, PLC
• Waters of Kingsport LLC
• Kathleen Waters
• Casey Elizabeth Watkins, MD
• Jeff Watkins, PHARMD
• Barry B. Watson, O.D.

• Ambulatory Surgical Clinic/Center in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Ambulatory Surgical Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.