MEDICARE: ADVENTHEALTH PRIMARY CARE RMR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1194650432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVENTHEALTH PRIMARY CARE RMR

Provider Business Mailing Address
First Line	:	2600 WESTHALL LN STE 300
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-7107
Country	:	US
Telephone Number	:	407-200-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	4344 WOODLANDS BLVD STE 260
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-2801
Country	:	US
Telephone Number	:	303-649-3155
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	DESTIN HARCUS
Credential	:
Telephone Number	:	407-357-1243

Provider Enumeration Date	:	06/17/2026
Last Update Date	:	06/18/2026

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