Provider Demographics
NPI:1548824824
Name:ADVENTIST HEALTH SYSTEM-SUNBELT INC ADVENTHEALTH ORLANDO
Entity type:Organization
Organization Name:ADVENTIST HEALTH SYSTEM-SUNBELT INC ADVENTHEALTH ORLANDO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-303-7388
Mailing Address - Street 1:PO BOX 540419
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32854-0419
Mailing Address - Country:US
Mailing Address - Phone:407-944-3198
Mailing Address - Fax:407-944-3199
Practice Address - Street 1:2400 N ORANGE BLOSSOM TRAIL
Practice Address - Street 2:SUITE 10
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744
Practice Address - Country:US
Practice Address - Phone:407-944-3198
Practice Address - Fax:407-944-3199
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVENTIST HEALTH SYSTEM-SUNBELT INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-23
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109009300Medicaid