NPIMap

Organization Active NPI

Mayo Clinic Health System in Waycross, Inc.

  • Multi-Specialty Clinic/Center
  • Waycross, GA
National Provider Identifier
1154745982
Registry record updated Aug 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
MAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC.
Practice address
1900 Tebeau St
Waycross, GA 31501-6357
Phone
(912) 283-3030
NPI assigned
Feb 14, 2014
Last updated
Aug 15, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2016

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

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

1900 Tebeau St
Waycross, GA 31501-6357

Mailing address

1900 Tebeau St
Waycross, GA 31501-6357
Phone (912) 283-3030

Other names 1

  • Mayo Clinic Health System Physicians in Waycross, Inc. Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040308000639 GA Part B Supplier - Clinic/Group Practice 0042124919 Receives reassigned benefits from 79 practitioners
4 other NPIs on this enrollment
Practice locations: Waycross, GA; Douglas, GA; Blackshear, GA; Alma, GA

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Member of 2

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

Locations

316 Shirley Ave
Douglas, GA 31533
Phone (912) 383-0815

1707 Boulevard Sq
Ste A
Waycross, GA 31501
Phone (912) 490-0078

1908 Alice St
Waycross, GA 31501
Phone (912) 338-6010

1921 Alice St
Ste 4B
Waycross, GA 31501
Phone (912) 285-5690

1921 Alice St
Ste 5A
Waycross, GA 31501
Phone (912) 283-4747

413 Lister St
Waycross, GA 31501
Phone (912) 287-0800

Practitioners & affiliated clinicians

Practitioners 213

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.

View all 213

NPI Registry JSON

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

{
    "created_epoch": "1392336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471219200000",
    "number": "1154745982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 TEBEAU ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315016357",
            "telephone_number": "912-283-3030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 TEBEAU ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315016357",
            "telephone_number": "912-283-3030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-14",
        "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": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mayo Clinic Health System Physicians in Waycross, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Waycross, GA

Sources for this page

  • 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.
  • 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.