1457458986 NPI number — ADVENTIST HEALTH SYSTEM-SUNBELT INC

Table of content: HEIDI REBECCA TAYLOR DO (NPI 1730334202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457458986 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 WAUCHULA-SWING BED
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:
1457458986
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4200 SUN N LAKE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEBRING
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33872-1986
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-402-3366
Provider Business Mailing Address Fax Number:
863-402-3110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
735 S 5TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUCHULA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33873-3158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-773-3101
Provider Business Practice Location Address Fax Number:
863-773-0126
Provider Enumeration Date:
09/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMASON
Authorized Official First Name:
NATHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
863-402-3366

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  4239 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010260100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 308621 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 524 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: L5N . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 010260100 . This is a "MEDIPASS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 21310 . This is a "HEALTHEASE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 522 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 010260101 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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