Provider Demographics
NPI:1205106184
Name:ADVENTIST HEALTH SYSTEM SUNBELT INC
Entity type:Organization
Organization Name:ADVENTIST HEALTH SYSTEM SUNBELT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HENDERSON
Authorized Official - Middle Name:
Authorized Official - Last Name:PETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-200-2227
Mailing Address - Street 1:2005 N ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5532
Mailing Address - Country:US
Mailing Address - Phone:407-303-6749
Mailing Address - Fax:
Practice Address - Street 1:2005 N ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5532
Practice Address - Country:US
Practice Address - Phone:407-303-6749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLYCEMIC MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-09
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0007OtherMEDICARE GROUP NUMBER