Provider Demographics
| NPI: | 1164698809 |
|---|---|
| Name: | ADVENTIST HEALTH SYSTEM-SUNBELT INC |
| Entity Type: | Organization |
| Organization Name: | ADVENTIST HEALTH SYSTEM-SUNBELT INC |
| Other - Org Name: | ADVENTHEALTH MEDICAL GROUP OB GYN AT SEBRING |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | CFO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | NATHAN |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | THOMASON |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 863-402-3366 |
| Mailing Address - Street 1: | 4200 SUN N LAKE BLVD |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SEBRING |
| Mailing Address - State: | FL |
| Mailing Address - Zip Code: | 33872-1986 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 863-402-3366 |
| Mailing Address - Fax: | 863-402-3110 |
| Practice Address - Street 1: | 4200 SUN N LAKE BLVD |
| Practice Address - Street 2: | |
| Practice Address - City: | SEBRING |
| Practice Address - State: | FL |
| Practice Address - Zip Code: | 33872-1986 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 863-402-3366 |
| Practice Address - Fax: | 863-402-3110 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | ADVENTIST HEALTH SYSTEM-SUNBELT INC |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2008-05-02 |
| Last Update Date: | 2023-01-31 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | Group - Multi-Specialty |
| No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
| No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Multi-Specialty |
| No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
| No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
| No | 363LX0001X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| FL | 0109 | Medicare PIN |
