Mayo Clinic Health System in Waycross, Inc.
Organization Active NPI Multi-Specialty Clinic/Center · Waycross, GA
NPI 1154745982 · NPPES record last updated Aug 15, 2016
Key facts
- NPI
- 1154745982
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Multi-Specialty Clinic/Center 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
- Organization subpart
- No
Authorized official
- Name
- George Hoffman
- Title
- Cfo
- Phone
- (912) 287-4213
Other NPIs on the same Medicare enrollment 4
Member of 2
Practitioners 213
-
Angela D Adams, FNP-C
-
Nisha Panicker Aravindakshan Patel, MD, MPH
-
Mary Hannah Benek, CNM MN
-
Yolanda Machelle Borders, M.D.
-
Jill G Bryant, MD
-
Aristotle Cochon, M.D.
-
Robert Darrell Collins, D.O.
-
Alicia Marie Conn, FNP, PMHNP-BC
-
Gregory Robert Crawley, M.D.
-
Amanda Davis Herin, M.D.
-
John R Duttenhaver, M.D.
-
Jose E Espinel, MD
-
Dennis A Fields, D.O.
-
Robert Rajesh Francilin F., M.D.,
-
Charles Galea, M.D.
-
Howard Griffin, MD
-
Terza Denise Harper, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
413 Lister St
Waycross, GA 31501
Phone (912) 287-0800
808 Beacon St
Waycross, GA 31501
Phone (912) 490-0722
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CJ0931 | Other | RAILROAD PTAN |
Other names
- Mayo Clinic Health System Physicians in Waycross, Inc.
Other providers in Waycross, GA
- Scott Mathis
- Diana Maurer
- 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
- Randall W McCarthy
All providers in Waycross, GA · Multi-Specialty Clinic/Center in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 15, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.