=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811159643
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVENTIST HEALTH SYSTEMS SUNBELT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2008
-----------------------------------------------------
Last Update Date | 02/05/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8701 MAITLAND SUMMIT BLVD
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32810-5915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-916-4540
-----------------------------------------------------
Fax | 407-916-4545
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 901 N LAKE DESTINY RD SUITE 400
-----------------------------------------------------
City | MAITLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32751-4844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-200-2860
-----------------------------------------------------
Fax | 407-200-1365
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SCOTT C. BRADY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 407-200-2860
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332900000X
-----------------------------------------------------
Taxonomy Name | Non-Pharmacy Dispensing Site
-----------------------------------------------------
License Number | ME 57207
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------