Healthcare Provider Details

I. General information

NPI: 1982006391
Provider Name (Legal Business Name): VARIETY CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8895 SW 136TH ST
MIAMI FL
33176-5816
US

IV. Provider business mailing address

PO BOX 862219
ORLANDO FL
32886-2219
US

V. Phone/Fax

Practice location:
  • Phone: 305-256-5480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number4067
License Number StateFL

VIII. Authorized Official

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