1487170684 NPI number — ADVENTIST HEALTH SYSTEM/SUNBELT, INC.

Table of content: (NPI 1487170684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487170684 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 TOTAL HEALTH MANAGEMENT - WINTER GARDEN VILLAGE
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:
1487170684
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 WESTHALL LN STE 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:
32751-7107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-200-2300
Provider Business Mailing Address Fax Number:
407-200-1353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3005 DANIELS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTER GARDEN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34787-7002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-200-2300
Provider Business Practice Location Address Fax Number:
407-200-1353
Provider Enumeration Date:
08/18/2017

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
Authorized Official Telephone Number:
407-200-2300

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DL090B . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".