1043514656 NPI number — ADVENTIST HEALTH SYSTEM/SUNBELT, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043514656 NPI number — ADVENTIST HEALTH SYSTEM/SUNBELT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVENTIST HEALTH SYSTEM/SUNBELT, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADVENTHEALTH CENTRA CARE - MOUNT DORA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043514656
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 WESTHALL LANE, BOX 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAITLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-200-2300
Provider Business Mailing Address Fax Number:
407-200-1365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19015 U.S. HIGHWAY 441
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT DORA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-383-3484
Provider Business Practice Location Address Fax Number:
352-735-0517
Provider Enumeration Date:
12/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BRADY
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
407-200-2300

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332900000X , with the licence number: ME 57207 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: B90C8 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 013961704 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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