WATAUGA ORTHOPAEDICS, PLC (NPI# 1104125210) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104125210 |
| Entity Type | Organization |
| Organization Name | WATAUGA ORTHOPAEDICS, PLC |
| Other Organization Name | WATAUGA ORTHOPAEDICS OF KINGSPORT |
| Practice Address |
875 Larry Neil Way Kingsport TN 37601 |
| Mailing Address |
2410 Susannah Street Johnson City TN 37601 |
| Practice Telephone | 4232829011 |
| Practice Fax Number | 4232820035 |
| Mailing Telephone | 4232829011 |
| Mailing Fax Number | 4232820035 |
| Enumeration Date | 2011-03-16 |
| Last Update Date | 2019-12-09 |
| Authorized Official Name | MRS. MARTHA D CHRISTENSEN (ADMINISTRATIVE ASSISTANT) |
| Authorized Official Telephone | 4232829011 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207X00000X | Orthopaedic Surgery | TN | Allopathic & Osteopathic Physicians | |
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 363A00000X | Physician Assistant | TN | Physician Assistants & Advanced Practice Nursing Providers | |
| Y | 332B00000X | Durable Medical Equipment & Medical Supplies | TN | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 3706248 | 05 |
| Other Name | Type Code |
|---|---|
| Watauga Orthopaedics of Kingsport | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518508993 | Watauga Orthopaedics, Plc | Orthopaedic Surgery | 340 Steeles Rd, Bristol, TN 37620 | 2019-10-07 |
| Street Address |
875 LARRY NEIL WAY |
| City | KINGSPORT |
| State | TN |
| Zip Code | 37601 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942243746 | Jeffery Jay France | Orthopaedic Surgery | 875 Larry Neil Way, Kingsport, TN 37660-6368 | 2006-06-13 |
| 1740813476 | Aaron W Justus | Physical Therapy Assistant | 875 Larry Neil Way, Kingsport, TN 37660-6368 | 2020-02-21 |
| 1457876625 | Rachel Elaine Taylor | Physician Assistant | 875 Larry Neil Way, Kingsport, TN 37660-6368 | 2017-08-09 |
| 1295936391 | Eric D Parks | Family Medicine | 875 Larry Neil Way, Kingsport, TN 37660-6368 | 2007-05-29 |
| 1164593513 | Brandon Douglas Jones | Physician Assistant | 875 Larry Neil Way, Kingsport, TN 37660-6368 | 2006-11-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396381992 | Juan Carlos Simon Villegas Gomez | Specialist/Technologist | 1081 John Robert Bell Dr, Johnson City, TN 37601 | 2019-11-19 |
| 1629537279 | Jaima Suzanne Price | Hearing Instrument Specialist | 106 E Watauga Avenue, Johnson City, TN 37601 | 2019-03-13 |
| 1275004467 | Brittany Howell | Speech-Language Pathologist | 2114 E. Fairview Ave, Johnson City, TN 37601 | 2018-12-16 |
| 1194229948 | Heather Chantel Lester | Physical Therapist | 2114 E. Fairview Avenue, Johnson City, TN 37601 | 2018-03-19 |
| 1477061869 | Patrick Conway Reynolds | Specialist/Technologist | 1081 John Robert Bell Drive, Johnson City, TN 37601 | 2018-01-19 |
| 1790201135 | Surgical Services of East Tennessee PC | Surgery | 300 East Main St., Suite 301, Johnson City, TN 37601 | 2017-08-17 |
| 1073065694 | Davina Leah Reppond | Home Health | 1204 E Myrtle Ave, Johnsoncity, TN 37601 | 2016-10-31 |
| 1003365503 | Wendi Y Minutolo | Behavioral Analyst | 403 Princeton Rd Ste 3, Johnson City, TN 37601 | 2016-09-25 |
| 1306208798 | Rachel Anne Anderson | Nurse Practitioner | 1118 East Holston Avenue, Johnson City, TN 37601 | 2016-03-24 |
| 1932560976 | Kaydee Louise Davidson | Occupational Therapist | 3209 Bristol Highway, Johnson City, TN 37601 | 2016-03-18 |
| Find all providers in zip 37601 | ||||
| Taxonomy Code | 332B00000X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient’s use in the home and that are usable for an extended period of time. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801436365 | Amerita South Atlantic LLC | Durable Medical Equipment & Medical Supplies | 105 Jack White Dr Ste B, Kingsport, TN 37664-2364 | 2020-01-13 |
| 1245542737 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 130 W Ravine Rd Ste 101, Kingsport, TN 37660-3837 | 2010-07-13 |
| 1376876904 | Walgreen Co. | Durable Medical Equipment & Medical Supplies | 2790 E Stone Dr, Kingsport, TN 37660-5849 | 2009-09-15 |
| 1073707154 | Tennessee Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 2626 E Stone Dr Ste 90, Kingsport, TN 37660-5883 | 2007-08-31 |
| 1649344797 | Hanger Prosthetics & Orthotics Inc | Durable Medical Equipment & Medical Supplies | 2633 E Stone Dr Ste C & D, Kingsport, TN 37660-5921 | 2006-11-20 |
| 1316022296 | Mediserve Medical Equipment Inc | Durable Medical Equipment & Medical Supplies | 3200 Ft Henry Dr, Kingsport, TN 37664 | 2006-10-26 |
| 1992880876 | Mediserve Medical Equipment of Kingsport, Inc | Durable Medical Equipment & Medical Supplies | 444 Clinchfield St Ste 2201, Kingsport, TN 37660-3858 | 2006-10-26 |
| 1760580609 | Mac's Medicine Mart, Inc | Durable Medical Equipment & Medical Supplies | 1455 E Center St, Kingsport, TN 37664-2501 | 2006-09-21 |
| 1710080445 | Tennessee Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 5215 Memorial Blvd, Suite 20, Kingsport, TN 37664 | 2006-09-07 |
| 1114932134 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1420 W Stone Dr, Kingsport, TN 37660-2522 | 2006-07-29 |
| Find all providers in KINGSPORT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.