1447382676 NPI number — VARIETY CHILDREN'S HOSPITAL

Table of content: (NPI 1447382676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447382676 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:
Provider Other Organization Name Type Code:
6
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:
1447382676
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 865095
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:
32886-5095
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-624-5876
Provider Business Mailing Address Fax Number:
786-624-2688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 SW 62ND AVE
Provider Second Line Business Practice Location Address:
DEPARTMENT OF ORTHOPEDICS
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33155-3009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-662-8366
Provider Business Practice Location Address Fax Number:
305-663-9194
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MENOCAL
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
305-662-8357

Provider Taxonomy Codes

  • Taxonomy code: 207XP3100X , with the licence number:  574498-3 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 255772000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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