Healthcare Provider Details

I. General information

NPI: 1023056777
Provider Name (Legal Business Name): VARIETY CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 03/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 SW 62ND CT
MIAMI FL
33155-3069
US

IV. Provider business mailing address

PO BOX 863940
ORLANDO FL
32886-3940
US

V. Phone/Fax

Practice location:
  • Phone: 305-669-6505
  • Fax: 305-669-6447
Mailing address:
  • Phone: 786-624-5876
  • Fax: 786-624-2688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY BIRKENSTOCK
Title or Position: CFO & SENIOR VP
Credential:
Phone: 305-666-6511