Healthcare Provider Details

I. General information

NPI: 1578725941
Provider Name (Legal Business Name): ADVENTIST HEALTH SYSTEM-SUNBELT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 CARLTON ST
WAUCHULA FL
33873-3408
US

IV. Provider business mailing address

4200 SUN N LAKE BLVD
SEBRING FL
33872-1986
US

V. Phone/Fax

Practice location:
  • Phone: 863-402-3366
  • Fax: 863-402-3110
Mailing address:
  • Phone: 863-402-3366
  • Fax: 863-402-3110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

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