1043453905 NPI number — ADVENTIST HEALTH SYSTEM-SUNBELT INC

Table of content: (NPI 1043453905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043453905 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:
Provider Other Organization Name Type Code:
6
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:
1043453905
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 540419
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32854
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-303-2907
Provider Business Mailing Address Fax Number:
407-303-5988

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 E ROLLINS ST
Provider Second Line Business Practice Location Address:
GINSBURG TOWER 1ST FLR
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32803-1248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-303-1962
Provider Business Practice Location Address Fax Number:
407-303-7486
Provider Enumeration Date:
04/08/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
407-303-7388

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PH23983 , 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: 001319200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1045423 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001319201 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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