Mayo Clinic Health System in Waycross, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1-113-1108 Issued in GA

Legal business name

MAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC.

Practice address

221 Carter Ave.
Blackshear, GA 31516

Phone

(912) 449-6631

Fax

(912) 449-3840

NPI assigned

Jun 24, 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

• Pierce County Nursing Home Doing business as

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471219200000",
    "number": "1366478042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 CARTER AVE.",
            "city": "BLACKSHEAR",
            "state": "GA",
            "postal_code": "31516",
            "telephone_number": "912-449-6631",
            "fax_number": "912-449-3840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 CARTER AVE.",
            "city": "BLACKSHEAR",
            "state": "GA",
            "postal_code": "31516",
            "telephone_number": "912-449-6631",
            "fax_number": "912-449-3840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "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": "1-113-1108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00142447A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pierce County Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Blackshear, GA
• 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.