Provider Demographics
NPI:1548416571
Name:VARIETY CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:VARIETY CHILDREN'S HOSPITAL
Other - Org Name:MCH SPECIALISTS- ORTHOPEDIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP & 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:305-669-6422
Mailing Address - Street 1:PO BOX 863941
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3941
Mailing Address - Country:US
Mailing Address - Phone:305-662-8334
Mailing Address - Fax:786-624-5881
Practice Address - Street 1:3601 NW 107TH AVE
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4377
Practice Address - Country:US
Practice Address - Phone:786-624-3672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIAMI CHILDREN'S HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-11
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6961Medicare PIN