NPIMap

Organization Active NPI

Watauga Medical Center Inc

  • Sleep Medicine (Psychiatry & Neurology) Physician
  • Boone, NC
National Provider Identifier
1265068027
Registry record updated Jan 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084S0012X
Legal business name
WATAUGA MEDICAL CENTER INC
Practice address
336 Deerfield Rd
Boone, NC 28607-5008
Phone
(828) 262-4133
Fax
(828) 262-4103
NPI assigned
Mar 12, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2025

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

Authorized official

Name
Mary Etta Long
Title
SVP
Phone
(828) 262-4133

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Medicine (Psychiatry & Neurology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084S0012X Primary

Addresses

Primary practice location

336 Deerfield Rd
Boone, NC 28607-5008

Mailing address

PO Box 2600
Boone, NC 28607-2600
Phone (828) 262-4133

Other names 1

  • Neurology Consultation Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1583971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736294400000",
    "number": "1265068027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2600",
            "city": "BOONE",
            "state": "NC",
            "postal_code": "286072600",
            "telephone_number": "828-262-4133",
            "fax_number": "828-262-4103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "336 DEERFIELD RD",
            "city": "BOONE",
            "state": "NC",
            "postal_code": "286075008",
            "telephone_number": "828-262-4133",
            "fax_number": "828-262-4103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATAUGA MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-12",
        "last_updated": "2025-01-08",
        "certification_date": "2025-01-08",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ETTA",
        "authorized_official_title_or_position": "SVP",
        "authorized_official_telephone_number": "828-262-4133"
    },
    "taxonomies": [
        {
            "code": "2084S0012X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Neurology Consultation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Neurology Consultation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boone, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.