Provider Demographics
NPI:1659938637
Name:ADVENTIST HEALTH SYSTEM-SUNBELT INC ADVENTHEALTH ORLANDO
Entity Type:Organization
Organization Name:ADVENTIST HEALTH SYSTEM-SUNBELT INC ADVENTHEALTH ORLANDO
Other - Org Name:ADVENTHEALTH OUTPATIENT PHARMACY WINTER PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-303-7388
Mailing Address - Street 1:PO BOX 540419
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32854-0419
Mailing Address - Country:US
Mailing Address - Phone:407-944-3198
Mailing Address - Fax:407-944-3198
Practice Address - Street 1:2005 MIZELL AVENUE
Practice Address - Street 2:SUITE 900
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792
Practice Address - Country:US
Practice Address - Phone:407-646-7263
Practice Address - Fax:407-646-7264
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVENTIST HEALTH SYSTEM-SUNBELT INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-24
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110256100Medicaid