Healthcare Provider Details

I. General information

NPI: 1043514656
Provider Name (Legal Business Name): ADVENTIST HEALTH SYSTEM/SUNBELT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2010
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19015 U.S. HIGHWAY 441
MOUNT DORA FL
32757
US

IV. Provider business mailing address

2600 WESTHALL LANE, BOX 300
MAITLAND FL
32751
US

V. Phone/Fax

Practice location:
  • Phone: 352-383-3484
  • Fax: 352-735-0517
Mailing address:
  • Phone: 407-200-2300
  • Fax: 407-200-1365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberME 57207
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: SCOTT C. BRADY
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 407-200-2300