Provider Demographics
NPI:1720172224
Name:ADVENTIST HEALTH SYSTEMS SUNBELT INC
Entity Type:Organization
Organization Name:ADVENTIST HEALTH SYSTEMS SUNBELT INC
Other - Org Name:LOCH HAVEN OB/GYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CED
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:
Authorized Official - Last Name:TOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-303-1531
Mailing Address - Street 1:235 E.PRINCETON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804
Mailing Address - Country:US
Mailing Address - Phone:407-303-1444
Mailing Address - Fax:407-303-1446
Practice Address - Street 1:235 E. PRINCETON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804
Practice Address - Country:US
Practice Address - Phone:407-303-1444
Practice Address - Fax:407-303-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL97809OtherBLUE CROSS
FL0476716OtherAETNA HMO EPO
FLCB 1994OtherMEDICARE RAILROAD
FL010129012Medicaid
FL4578757OtherAETNA PPO
FL97809OtherBLUE CROSS
FL97809OtherBLUE CROSS