Healthcare Provider Details

I. General information

NPI: 1194122200
Provider Name (Legal Business Name): ADVENTIST HEALTH SYSTEM/SUNBELT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 W FAIRBANKS AVE
WINTER PARK FL
32789-4511
US

IV. Provider business mailing address

2600 WESTHALL LN BOX 300
MAITLAND FL
32751-7102
US

V. Phone/Fax

Practice location:
  • Phone: 407-200-2300
  • Fax: 407-200-1353
Mailing address:
  • Phone: 407-200-2300
  • Fax: 407-200-1353

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 Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SCOTT C BRADY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 407-200-2807