NPIMap

Organization Active NPI

Watauga Pathology Associates PC

  • Anatomic Pathology & Clinical Pathology Physician
  • Johnson City, TN
National Provider Identifier
1720053945
Registry record updated Feb 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
MD0000015437 Issued in TN
Legal business name
WATAUGA PATHOLOGY ASSOCIATES PC
Practice address
400 N State of Franklin Rd
Johnson City, TN 37604-6035
Phone
(423) 431-6388
Fax
(423) 431-6331
NPI assigned
Feb 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2008

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

Authorized official

Name
Dr. David Richard Soike, MD
Title
President
Phone
(423) 431-6388

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cytopathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZC0500X MD0000020115 TN
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZP0102X MD0000015437 TN Primary

Addresses

Primary practice location

400 N State of Franklin Rd
Johnson City, TN 37604-6035

Mailing address

PO Box 52990
Greenwood, SC 29649-0048
Phone (864) 223-3600

Other identifiers 1

IdentifierTypeStateIssuer
3384912MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070919000360 TN Part B Supplier - Clinic/Group Practice 4183718380 Receives reassigned benefits from 12 practitioners
1 other NPI on this enrollment
Practice locations: Johnson City, TN
O20221115002775 VA Part B Supplier - Clinic/Group Practice 4183718380 Receives reassigned benefits from 10 practitioners
Practice locations: Abingdon, VA; Marion, VA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

300 Med Tech Pkwy
Johnson City, TN 37604
Phone (423) 302-1000

2700 S Roan St
Ste 105
Johnson City, TN 37601
Phone (423) 283-0430

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203292800000",
    "number": "1720053945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 52990",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296490048",
            "telephone_number": "864-223-3600",
            "fax_number": "864-223-6054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N STATE OF FRANKLIN RD",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046035",
            "telephone_number": "423-431-6388",
            "fax_number": "423-431-6331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATAUGA PATHOLOGY ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-21",
        "last_updated": "2008-02-18",
        "status": "A",
        "authorized_official_last_name": "SOIKE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "423-431-6388",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZC0500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Cytopathology",
            "state": "TN",
            "license": "MD0000020115",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "TN",
            "license": "MD0000015437",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3384912",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.