1043452105 NPI number — VARIETY CHILDREN'S HOSPITAL

Table of content: (NPI 1043452105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043452105 NPI number — VARIETY CHILDREN'S HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VARIETY CHILDREN'S HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MCH PEDIATRIC CARE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043452105
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 863940
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32886-3940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-662-8334
Provider Business Mailing Address Fax Number:
786-624-2688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8740 N KENDALL DRIVE
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-630-2626
Provider Business Practice Location Address Fax Number:
305-630-2625
Provider Enumeration Date:
04/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BIRKENSTOCK
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR VP & CFO
Authorized Official Telephone Number:
305-669-6422

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010060917 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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