Provider Demographics
NPI:1679668669
Name:ADVENTIST HEALTH SYSTEM SUNBELT INC
Entity Type:Organization
Organization Name:ADVENTIST HEALTH SYSTEM SUNBELT INC
Other - Org Name:THE CENTER FOR SPECIALIZED SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LARS
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-303-1531
Mailing Address - Street 1:2415 N. ORANGE AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804
Mailing Address - Country:US
Mailing Address - Phone:407-303-7399
Mailing Address - Fax:407-303-7305
Practice Address - Street 1:2415 NORTH ORANGE AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804
Practice Address - Country:US
Practice Address - Phone:407-303-7399
Practice Address - Fax:407-303-7305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCA3498OtherMEDICARE RAILROAD
FL99794OtherBLUE CROSS
FL274870300Medicaid
FL274870300Medicaid