Provider Demographics
NPI:1467916866
Name:ADVENTIST HEALTH SYSTEM/SUNBELT, INC.
Entity Type:Organization
Organization Name:ADVENTIST HEALTH SYSTEM/SUNBELT, INC.
Other - Org Name:ADVENTHEALTH PRIMARY CARE PLUS S. LAKELAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-200-2300
Mailing Address - Street 1:2600 WESTHALL LN STE 300
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7107
Mailing Address - Country:US
Mailing Address - Phone:407-200-2300
Mailing Address - Fax:
Practice Address - Street 1:6419 S FLORIDA AVE STE 109
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3353
Practice Address - Country:US
Practice Address - Phone:407-200-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVENTHEALTH TOTAL HEALTH MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-30
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDL090BOtherMEDICARE
FL111754210Medicaid