Healthcare Provider Details

I. General information

NPI: 1396413076
Provider Name (Legal Business Name): ADVENTIST HEALTH SYSTEM SUNBELT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 US 27 S
LAKE PLACID FL
33852-7904
US

IV. Provider business mailing address

ADVENTHEALTH MANAGED CARE 900 HOPE WAY
ALTAMONTE SPRINGS FL
32714-1502
US

V. Phone/Fax

Practice location:
  • Phone: 863-465-6200
  • Fax:
Mailing address:
  • Phone: 407-357-1927
  • Fax: 407-357-1679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NATHAN THOMASON
Title or Position: CFO
Credential:
Phone: 863-402-3366