NPIMap

Organization Active NPI

Centurion Surgery Center of Waycross LLC

  • Ambulatory Surgical Clinic/Center
  • Waycross, GA
National Provider Identifier
1902653884
Registry record updated Jul 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
CENTURION SURGERY CENTER OF WAYCROSS LLC
Practice address
1218 Alice St Ste B
Waycross, GA 31501-4525
Phone
(912) 590-0973
Fax
(912) 590-0180
NPI assigned
Apr 30, 2024
Last updated
Jul 14, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2025

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

Authorized official

Name
Alicia Groth
Title
Credentialing Manager
Phone
(904) 256-2754

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X NU Primary

Addresses

Primary practice location

1218 Alice St Ste B
Waycross, GA 31501-4525

Mailing address

5191 First Coast Tech Pkwy FL 3
Jacksonville, FL 32224-0609
Phone (904) 223-3321

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250520000403 GA Part B Supplier - Ambulatory Surgical Center 9335667732 Practice locations: Waycross, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902653884. Details of each certification follow.

Ambulatory surgical center certification: CCN 11C0001587

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Centurion Surgery OF Waycross, LLC
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Apr 17, 2025
Last certification
Apr 17, 2025
Ownership / control type
Proprietary
Facility address
1218 Alice Street Suite B
Waycross, GA 31501

National Provider Directory

National Provider Directory

Member of 1

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

Locations

1218 Alice St
Ste B
Waycross, GA 31501
Phone (912) 590-0973

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1714435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752451200000",
    "number": "1902653884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5191 FIRST COAST TECH PKWY FL 3",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322240609",
            "telephone_number": "904-223-3321",
            "fax_number": "904-223-2169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1218 ALICE ST STE B",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315014525",
            "telephone_number": "912-590-0973",
            "fax_number": "912-590-0180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTURION SURGERY CENTER OF WAYCROSS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-30",
        "last_updated": "2025-07-14",
        "certification_date": "2025-07-14",
        "status": "A",
        "authorized_official_last_name": "GROTH",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "904-256-2754"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waycross, GA

Sources for this page

Verify at the official NPI Registry.