Basic Information
| Provider Information | |||||||||
| NPI: | 1083692594 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ADVENTIST HEALTH SYSTEM-SUNBELT INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ADVENTHEALTH SURGERY CENTER SEBRING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4200 SUN N LAKE BLVD | ||||||||
| Address2: | |||||||||
| City: | SEBRING | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338721986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634023366 | ||||||||
| FaxNumber: | 8634023110 | ||||||||
| Practice Location | |||||||||
| Address1: | 4200 SUN N LAKE BLVD | ||||||||
| Address2: | |||||||||
| City: | SEBRING | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338721986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634023366 | ||||||||
| FaxNumber: | 8634023110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2006 | ||||||||
| LastUpdateDate: | 09/14/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | OLIVER | ||||||||
| AuthorizedOfficialFirstName: | ROSALIE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8634023366 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 4171 | FL | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 308621 | 01 | FL | FEDERAL BLACK LUNG | OTHER | 522 | 01 | FL | BLUE CROSS/BLUE SHIELD | OTHER | X1549 | 01 | FL | BLUE CROSS OTHER PROVIDER | OTHER | 010090100 | 01 | FL | MEDIPASS | OTHER | 010090100 | 05 | FL | MEDICAID | 21310 | 01 | FL | HEALTHEASE | OTHER |