=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952358418
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VARIETY CHILDREN'S HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2006
-----------------------------------------------------
Last Update Date | 10/14/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3100 SW 62ND AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-3009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-666-6511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 865095
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32886-5095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-624-5876
-----------------------------------------------------
Fax | 786-624-2688
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATIVE DIRECTOR., RCM
-----------------------------------------------------
Name | MS. REBECCA FRANCE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-624-5876
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------