Healthcare Provider Details

I. General information

NPI: 1740422989
Provider Name (Legal Business Name): VARIETY CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 S COMMERCE PKWY
WESTON FL
33331-3622
US

IV. Provider business mailing address

PO BOX 863940
ORLANDO FL
32886-3940
US

V. Phone/Fax

Practice location:
  • Phone: 954-385-6274
  • Fax:
Mailing address:
  • Phone: 305-662-8334
  • Fax: 786-624-2688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

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