Healthcare Provider Details

I. General information

NPI: 1992630677
Provider Name (Legal Business Name): ADVENTHEALTH PRIMARY CARE MAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 KESSLER ST STE 300
MERRIAM KS
66204-2550
US

IV. Provider business mailing address

2600 WESTHALL LN STE 300
MAITLAND FL
32751-7107
US

V. Phone/Fax

Practice location:
  • Phone: 913-632-2900
  • Fax:
Mailing address:
  • Phone: 407-200-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DESTIN HARCUS
Title or Position: CFO
Credential:
Phone: 407-357-1243