Provider Demographics
NPI:1518360700
Name:VARIETY CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:VARIETY CHILDREN'S HOSPITAL
Other - Org Name:NICKLAUS CHILDREN'S HOSPITAL - AVENTURA CARE 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 1:20295 NE 29TH PL
Practice Address - Street 2:SUITE 300
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-4109
Practice Address - Country:US
Practice Address - Phone:786-624-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VAREITY CHILDREN HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-01
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Multi-Specialty
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/ImmunologyGroup - Multi-Specialty
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Multi-Specialty
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Multi-Specialty
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Multi-Specialty
No2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric NephrologyGroup - Multi-Specialty
No2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric RheumatologyGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric RadiologyGroup - Multi-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Multi-Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No282NC2000XHospitalsGeneral Acute Care HospitalChildrenGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010060921Medicaid