Renue Surgery Center of Waycross, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

RENUE SURGERY CENTER OF WAYCROSS, LLC

Practice address

1905 Tebeau St
Waycross, GA 31501-6356

Phone

(912) 280-9977

Fax

(912) 280-9995

NPI assigned

Mar 18, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Charles William Mitchell, M.D.NPI 1912913609

Title

Manager

Phone

(912) 280-9977

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Listed as

Renue Surgery Center of WaycrossCCN 11C0001381

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

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

• Renue Plastic Surgery, LLC

  • Plastic and Reconstructive Surgery Physician
  • Brunswick, GA
  • NPI 1881609543

  Member Of

  NPD member

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Charles W. Mitchell, M.D.

  • Plastic Surgery Physician
  • Brunswick, GA
  • NPI 1912913609
  NPD Authorized official

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

{
    "created_epoch": "1300406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603843200000",
    "number": "1821397654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2198",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315212198",
            "telephone_number": "912-280-9977",
            "fax_number": "912-280-9995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 TEBEAU ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315016356",
            "telephone_number": "912-280-9977",
            "fax_number": "912-280-9995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENUE SURGERY CENTER OF WAYCROSS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-18",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "912-280-9977",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Brent Ray, DPM
• Matthew Reed
• Rachel Nicole Reesehoward
• Kierra Alexis Reid, SLP
• Michelle Reid
• Jana Revels, NP
• Cullee Peavey Richardson, PA-C
• David A Rios, PA
• Yolanda L Rivers, PHARMD
• April Roberson

• Ambulatory Surgical Clinic/Center in Waycross, GA
• Providers in Waycross, GA by specialty
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.