Provider Demographics
NPI:1760299093
Name:ADVENTHEALTH PORT CHARLOTTE INC
Entity type:Organization
Organization Name:ADVENTHEALTH PORT CHARLOTTE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:VADYM
Authorized Official - Middle Name:
Authorized Official - Last Name:DIDENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-803-4004
Mailing Address - Street 1:14055 RIVEREDGE DR STE 250
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33637-2141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5000
Practice Address - Country:US
Practice Address - Phone:941-766-4122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-11
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital