Provider Demographics
| NPI: | 1225034234 |
|---|---|
| Name: | FLORIDA HOSPITAL MEDICAL GROUP INC |
| Entity Type: | Organization |
| Organization Name: | FLORIDA HOSPITAL MEDICAL GROUP INC |
| Other - Org Name: | ADVENTHEALTH MEDICAL GROUP |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | COO |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | VANCE |
| Authorized Official - Middle Name: | ALAN |
| Authorized Official - Last Name: | MCLARREN |
| Authorized Official - Suffix: | II |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 407-200-2700 |
| Mailing Address - Street 1: | 2600 WESTHALL LN FL 4 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | MAITLAND |
| Mailing Address - State: | FL |
| Mailing Address - Zip Code: | 32751-7102 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 407-200-2700 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 2600 WESTHALL LN FL 4 |
| Practice Address - Street 2: | |
| Practice Address - City: | MAITLAND |
| Practice Address - State: | FL |
| Practice Address - Zip Code: | 32751-7102 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 407-200-2700 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2005-06-23 |
| Last Update Date: | 2023-03-31 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| FL | NA | 103G00000X, 204F00000X, 207Q00000X, 207R00000X, 207V00000X, 207X00000X, 208000000X, 2084P0800X, 208600000X, 208C00000X, 208D00000X, 208M00000X, 363A00000X, 363L00000X |
| 207RH0003X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
| No | 204F00000X | Allopathic & Osteopathic Physicians | Transplant Surgery | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208C00000X | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | Group - Multi-Specialty | |
| No | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
| No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| FL | 252226801 | Medicaid | |
| FL | 252226811 | Medicaid | |
| FL | 252226806 | Medicaid | |
| FL | 252226809 | Medicaid | |
| FL | 252226814 | Medicaid | |
| FL | 252226818 | Medicaid | |
| FL | 252226802 | Medicaid | |
| FL | 252226808 | Medicaid | |
| FL | 252226810 | Medicaid | |
| FL | 252226812 | Medicaid | |
| FL | 252226813 | Medicaid | |
| FL | 252226800 | Medicaid | |
| FL | 252226805 | Medicaid | |
| FL | 252226807 | Medicaid | |
| FL | 24567 | Other | BCBS FL |
| FL | 252226804 | Medicaid | |
| FL | 252226813 | Medicaid | |
| FL | 252226805 | Medicaid | |
| FL | 252226806 | Medicaid | |
| FL | 40811 | Medicare PIN |
