NPIMap

Organization Active NPI

Watauga Medical Center Inc

  • Hematology & Oncology Physician
  • Boone, NC
National Provider Identifier
1972308930
Registry record updated Feb 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
Legal business name
WATAUGA MEDICAL CENTER INC
Practice address
1200 State Farm Rd
Boone, NC 28607-4994
Phone
(828) 262-4332
Fax
(828) 265-5514
NPI assigned
Feb 14, 2025
Last updated
Feb 14, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
WATAUGA MEDICAL CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 14, 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 Medical Staff Relations
Phone
(828) 262-4133

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RH0003X Primary

Addresses

Primary practice location

1200 State Farm Rd
Boone, NC 28607-4994

Mailing address

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

Other names 1

  • Medical Oncology Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250411001791 NC Part B Supplier - Clinic/Group Practice 2668377474 Receives reassigned benefits from 6 practitioners
Practice locations: Boone, NC

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Blue Ridge Physcial Therapy

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1739491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739491200000",
    "number": "1972308930",
    "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": "1200 STATE FARM RD",
            "city": "BOONE",
            "state": "NC",
            "postal_code": "286074994",
            "telephone_number": "828-262-4332",
            "fax_number": "828-265-5514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATAUGA MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WATAUGA MEDICAL CENTER INC",
        "enumeration_date": "2025-02-14",
        "last_updated": "2025-02-14",
        "certification_date": "2025-02-14",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ETTA",
        "authorized_official_title_or_position": "SVP MEDICAL STAFF RELATIONS",
        "authorized_official_telephone_number": "828-262-4133"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Oncology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Feb 14, 2025; 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.