Provider Demographics
NPI:1649223900
Name:RCOA-ADVENTIST HEALTH, LLC
Entity Type:Organization
Organization Name:RCOA-ADVENTIST HEALTH, LLC
Other - Org Name:ADVENTIST HEALTH PET/CT - REDBUD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-477-3500
Mailing Address - Street 1:P. O . BOX 850001
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0120
Mailing Address - Country:US
Mailing Address - Phone:866-293-3500
Mailing Address - Fax:866-293-3535
Practice Address - Street 1:18TH AVENUE AT HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:CLEARLAKE
Practice Address - State:CA
Practice Address - Zip Code:95422
Practice Address - Country:US
Practice Address - Phone:866-293-3500
Practice Address - Fax:866-293-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6838-17261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ66595ZOtherPROVIDER NUMBER
CAZZZ31885ZMedicare ID - Type UnspecifiedPROVIDER NUMBER