1871736975 NPI number — VARIETY CHILDERN'S HOSPITAL

Table of content: (NPI 1871736975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871736975 NPI number — VARIETY CHILDERN'S HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VARIETY CHILDERN'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 RADIOLOGY
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:
1871736975
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 863942
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:
32886-3942
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:
13400 SW 120TH ST
Provider Second Line Business Practice Location Address:
SUITE 100 & 200
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33186-7440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-624-5363
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2009

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: 2085P0229X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 256985007 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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