1811141633 NPI number — VARIETY CHILDREN'S HOPSITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811141633 NPI number — VARIETY CHILDREN'S HOPSITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VARIETY CHILDREN'S HOPSITAL
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 WEST KENDALL 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:
1811141633
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:
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:
305-666-6511
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/06/2008

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: 010060934 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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