1265648620 NPI number — VARIETY CHILDRENS HOSPITAL

Table of content: LINDSEY JULISSA LUNA (NPI 1508348194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265648620 NPI number — VARIETY CHILDRENS HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VARIETY CHILDRENS 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:
NICKLAUS CHILDREN'S PALMETTO BAY OUTPATIENT 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:
1265648620
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 SW 62ND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33155-3009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-666-6511
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17615 SW 97TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMETTO BAY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33157-5636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-268-1777
Provider Business Practice Location Address Fax Number:
786-268-1738
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ALFAU
Authorized Official First Name:
GEORGETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
PAYER CONTRACT/CREDENTIALING ANALYS
Authorized Official Telephone Number:
786-624-5795

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 282NC2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 010060931 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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