Provider Demographics
NPI:1841395811
Name:ADVENTIST HEALTH SYSTEM-SUNBELT INC DBA FLORIDA HOSPITAL
Entity Type:Organization
Organization Name:ADVENTIST HEALTH SYSTEM-SUNBELT INC DBA FLORIDA HOSPITAL
Other - Org Name:OVIEDO CHILDREN'S
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARS
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-303-5600
Mailing Address - Street 1:1410 W BROADWAY ST
Mailing Address - Street 2:#104
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6456
Mailing Address - Country:US
Mailing Address - Phone:407-977-1135
Mailing Address - Fax:407-977-9946
Practice Address - Street 1:1410 W BROADWAY ST
Practice Address - Street 2:#104
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6456
Practice Address - Country:US
Practice Address - Phone:407-977-1135
Practice Address - Fax:407-977-9946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010129011Medicaid
FLFHCOVOtherFHHS
FL010129011Medicaid
FL010129011Medicaid