Healthcare Provider Details

I. General information

NPI: 1659439156
Provider Name (Legal Business Name): ADVENTIST HEALTH SYSTEM-SUNBELT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 N ORANGE AVE SUITE 700
ORLANDO FL
32804-5505
US

IV. Provider business mailing address

2415 N ORANGE AVE SUITE 700
ORLANDO FL
32804-5505
US

V. Phone/Fax

Practice location:
  • Phone: 407-330-3247
  • Fax: 407-303-2478
Mailing address:
  • Phone: 407-330-3247
  • Fax: 407-303-2478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: HENDERSON PETER
Title or Position: DIRECTOR
Credential:
Phone: 407-200-2227