Provider Demographics
NPI:1154850709
Name:VARIETY CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:VARIETY CHILDREN'S HOSPITAL
Other - Org Name:NICKLAUS CHILDREN'S SPORTS HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PAYER CONTRACT/CREDENTIALING ANALYS
Authorized Official - Prefix:
Authorized Official - First Name:GEORGETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-624-5795
Mailing Address - Street 1:3100 SW 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3009
Mailing Address - Country:US
Mailing Address - Phone:305-666-6511
Mailing Address - Fax:
Practice Address - Street 1:11521 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-4445
Practice Address - Country:US
Practice Address - Phone:786-624-4600
Practice Address - Fax:786-624-4606
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VARIETY CHILDREN'S HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-07
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Multi-Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010060932Medicaid