Provider Demographics
NPI:1194910414
Name:ADVENTIST HEALTH SYSTEMS SUNBELT
Entity type:Organization
Organization Name:ADVENTIST HEALTH SYSTEMS SUNBELT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-200-2860
Mailing Address - Street 1:901 N LAKE DESTINY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4844
Mailing Address - Country:US
Mailing Address - Phone:407-200-2860
Mailing Address - Fax:407-200-1365
Practice Address - Street 1:7848 W IRLO BRONSON HWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747-1729
Practice Address - Country:US
Practice Address - Phone:407-397-7032
Practice Address - Fax:407-397-7041
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVENTIST HEALTH SYSTEMS SUNBELT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-10
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 38110332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00690Medicare PIN