Provider Demographics
NPI:1043453905
Name:ADVENTIST HEALTH SYSTEM-SUNBELT INC
Entity Type:Organization
Organization Name:ADVENTIST HEALTH SYSTEM-SUNBELT INC
Other - Org Name:ADVENTHEALTH OUTPATIENT PHARMACY GINSBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-303-7388
Mailing Address - Street 1:PO BOX 540419
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32854
Mailing Address - Country:US
Mailing Address - Phone:407-303-2907
Mailing Address - Fax:407-303-5988
Practice Address - Street 1:601 E ROLLINS ST
Practice Address - Street 2:GINSBURG TOWER 1ST FLR
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1248
Practice Address - Country:US
Practice Address - Phone:407-303-1962
Practice Address - Fax:407-303-7486
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVENTIST HEALTH SYSTEM/SUNBELT INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-08
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH239833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001319200Medicaid
1045423OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL001319201Medicaid