Healthcare Provider Details

I. General information

NPI: 1679846935
Provider Name (Legal Business Name): VARIETY CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2012
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 BISCAYNE BLVD
MIAMI FL
33137-3779
US

IV. Provider business mailing address

PO BOX 863942
ORLANDO FL
32886-3942
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-8334
  • Fax:
Mailing address:
  • Phone: 305-662-8334
  • Fax: 786-624-2688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number
License Number State

VIII. Authorized Official

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