Mayo Clinic Health System in Waycross, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

11481167 Issued in GA

Legal business name

MAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC.

Practice address

1600 Riverside Ave
Waycross, GA 31501-7028

Phone

(912) 283-1182

Fax

(912) 285-1578

NPI assigned

Jun 21, 2006

Organization subpart

No

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

Authorized official

Name

George Hoffman

Title

Cfo

Phone

(912) 287-4213

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• SATILLA CARE CENTER Doing business as

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Mayo Clinic

  • Clinical Medical Laboratory
  • Rochester, MN
  • NPI 1083249577

  Member Of

  NPD member
• Mayo Clinic Jacksonville

  • Ambulatory Surgical Clinic/Center
  • Jacksonville, FL
  • NPI 1962499079

  Member Of

  NPD member

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471219200000",
    "number": "1114963071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 RIVERSIDE AVE",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315017028",
            "telephone_number": "912-283-1182",
            "fax_number": "912-285-1578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 RIVERSIDE AVE",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315017028",
            "telephone_number": "912-283-1182",
            "fax_number": "912-285-1578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-21",
        "last_updated": "2016-08-15",
        "status": "A",
        "authorized_official_last_name": "HOFFMAN",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "912-287-4213"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": "11481167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000142755A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SATILLA CARE CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kalie Deann Mathis, NP-C
• Scott Mathis, APRN,BC
• Diana Maurer, O.D.
• Mayo Clinic Health System in Waycross
• Mayo Clinic Health System in Waycross, Inc
• Mayo Clinic Health System in Waycross, Inc.
• Mayo Clinic Health System in Waycross, Inc.
• Mayo Clinic Health System in Waycross, Inc.
• Mayo Clinic Health System in Waycross, Inc.
• Joshua Wade McCarthy, MD

• Skilled Nursing Facility in Waycross, GA
• Providers in Waycross, GA by specialty
• Skilled Nursing Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2016; 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.