Healthcare Provider Details

I. General information

NPI: 1215061999
Provider Name (Legal Business Name): VARIETY CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W. STUTERVANT STREET
ORLANDO FL
32806
US

IV. Provider business mailing address

PO BOX 863286
ORLANDO FL
32886-3286
US

V. Phone/Fax

Practice location:
  • Phone: 407-649-6907
  • Fax: 407-481-2035
Mailing address:
  • Phone: 305-662-8334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

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