Provider Demographics
NPI:1326402363
Name:VARIETY CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:VARIETY CHILDREN'S HOSPITAL
Other - Org Name:STUART CENTRAL PARK OFFICE
Other - Org Type:Other Name
Authorized Official - Title/Position:SVP AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRKENSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-624-6422
Mailing Address - Street 1:PO BOX 863286
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3286
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 SE CENTRAL PKWY
Practice Address - Street 2:SUITE 222
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-5913
Practice Address - Country:US
Practice Address - Phone:561-741-5628
Practice Address - Fax:772-266-8802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty