Provider Demographics
NPI:1255364550
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:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOGGESS
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:512-753-3505
Mailing Address - Street 1:1301 WONDER WORLD DR
Mailing Address - Street 2:CTMC (CENTRAL TEXAS MEDICAL CENTER)
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7533
Mailing Address - Country:US
Mailing Address - Phone:512-754-6159
Mailing Address - Fax:512-754-1657
Practice Address - Street 1:1315 I H 35 N
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7102
Practice Address - Country:US
Practice Address - Phone:512-754-6159
Practice Address - Fax:512-754-1657
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVENTIST HEALTH SYSTEM SUNBELT DBA CENTRAL TEXAS MEDICAL CENTER HOSPI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-09
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX002201251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2042Medicaid
TX451548Medicare ID - Type Unspecified
TX2042Medicaid