Provider Demographics
NPI:1679509459
Name:MIAMI CHILDRENS HOSPITAL
Entity Type:Organization
Organization Name:MIAMI CHILDRENS HOSPITAL
Other - Org Name:MIAMI CHILDRENS HOSPITAL PHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR PCHY SVS
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-663-8512
Mailing Address - Street 1:6125 SW 31ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3003
Mailing Address - Country:US
Mailing Address - Phone:305-669-7155
Mailing Address - Fax:305-669-6564
Practice Address - Street 1:6125 SW 31ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3003
Practice Address - Country:US
Practice Address - Phone:305-669-7155
Practice Address - Fax:305-669-6564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X, 3336S0011X
FLPH80013336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106585800Medicaid
FL106585801Medicaid
1034266OtherNCPDP PROVIDER IDENTIFICATION NUMBER