Healthcare Provider Details

I. General information

NPI: 1548416571
Provider Name (Legal Business Name): VARIETY CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 NW 107TH AVE
DORAL FL
33178-4377
US

IV. Provider business mailing address

PO BOX 863941
ORLANDO FL
32886-3941
US

V. Phone/Fax

Practice location:
  • Phone: 786-624-3672
  • Fax:
Mailing address:
  • Phone: 305-662-8334
  • Fax: 786-624-5881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY BIRKENSTOCK
Title or Position: SVP & CFO
Credential:
Phone: 305-669-6422