Provider Demographics
NPI:1164465944
Name:ADVENTIST HEALTH SYSTEM SUNBELT INC
Entity Type:Organization
Organization Name:ADVENTIST HEALTH SYSTEM SUNBELT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:512-753-3584
Mailing Address - Street 1:1999 MEDICAL PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7579
Mailing Address - Country:US
Mailing Address - Phone:512-753-3584
Mailing Address - Fax:512-392-8489
Practice Address - Street 1:1999 MEDICAL PKWY STE C
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7579
Practice Address - Country:US
Practice Address - Phone:512-753-3584
Practice Address - Fax:512-392-8489
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL TEXAS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-13
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX002191251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121789501Medicaid
TX457094OtherHUMANA INS GOLD CHC MCR
TXHH9142OtherBLUE CROSS BLUE SHIELD
TX457094OtherUNITED HEALTHCARE
TX457094OtherSTERLING LIFE MCR
TX121789501OtherSUPERIOR HEALTH PLAN
TX457094OtherHUMANA INS GOLD CHC MCR