Provider Demographics
NPI:1447382676
Name:VARIETY CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:VARIETY CHILDREN'S HOSPITAL
Other - Org Name:NICKLAUS CHILDREN'S HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MENOCAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-662-8357
Mailing Address - Street 1:PO BOX 865095
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-5095
Mailing Address - Country:US
Mailing Address - Phone:786-624-5876
Mailing Address - Fax:786-624-2688
Practice Address - Street 1:3100 SW 62ND AVE
Practice Address - Street 2:DEPARTMENT OF ORTHOPEDICS
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:305-662-8366
Practice Address - Fax:305-663-9194
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NICKLAUS CHILDREN'S HOSPITAL- ORTHOPEDIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-12
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL574498-3207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255772000Medicaid
FL255772000Medicaid