1457458986 NPI number — ADVENTIST HEALTH SYSTEM-SUNBELT INC

Table of content: (NPI 1457458986)

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:
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:
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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