Provider Demographics
NPI:1902243686
Name:FRYECARE WATAUGA, LLC
Entity Type:Organization
Organization Name:FRYECARE WATAUGA, LLC
Other - Org Name:MOUNTAIN FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL CFO, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:O
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-265-5009
Mailing Address - Street 1:245 WINKLERS CREEK RD
Mailing Address - Street 2:STE C
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-7838
Mailing Address - Country:US
Mailing Address - Phone:828-262-1800
Mailing Address - Fax:828-262-5444
Practice Address - Street 1:245 WINKLERS CREEK RD
Practice Address - Street 2:STE C
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-7838
Practice Address - Country:US
Practice Address - Phone:828-262-1800
Practice Address - Fax:828-262-5444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-04
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty