Healthcare Provider Details

I. General information

NPI: 1902061468
Provider Name (Legal Business Name): VARIETY CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

IV. Provider business mailing address

PO BOX 863941
ORLANDO FL
32886-3941
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

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