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General NPI Number Information
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NPI Number | 1720255904
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Entity Type | Organization
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Legal Business Name | VARIETY CHIDREN'S HOSPITAL
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 10/29/2014
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Provider Practice Location Address
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Address Line | 17615 SW 97TH AVE
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City | PALMETTO BAY
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State | FL
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Zip | 33157-5636
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Country | US
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Telephone | 305-662-8334
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 863942
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City | ORLANDO
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State | FL
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Zip | 32886-3942
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Country | US
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Telephone | 305-662-8334
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Fax |
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Authorized Official
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Title or Position | SENIOR VP & CFO
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Name | TIMOTHY BIRKENSTOCK
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Credential |
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Telephone | 305-669-6422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number |
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License Number State |
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