Provider Demographics
NPI:1952725079
Name:VARIETY CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:VARIETY CHILDREN'S HOSPITAL
Other - Org Name:MCH SPECIALIST
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:786-624-2688
Practice Address - Street 1:12246 MIRAMAR PARKWAY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025
Practice Address - Country:US
Practice Address - Phone:954-442-0809
Practice Address - Fax:954-442-0704
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIAMI CHLIDREM'S HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-10
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric OtolaryngologyGroup - Multi-Specialty
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Multi-Specialty
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Multi-Specialty
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6961Medicare PIN