Organization
VARIETY CHIDREN'S HOSPITAL
Active
Parent organization
MCH SPECIALIST RADIOLOGY
Other names
Miami Children's Hospital
Organization subpart
Yes
Provider details
NPI number
Legal business name
MCH SPECIALIST RADIOLOGY
Authorized official
TIMOTHY BIRKENSTOCK (SENIOR VP & CFO)
(305) 669-6422
Entity
Organization
Contact information
Practice address
17615 SW 97TH AVE, PALMETTO BAY, FL 33157-5636
(305) 662-8334
Mailing address
PO BOX 863942, ORLANDO, FL 32886-3942
(305) 662-8334
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
256985001
—
FL
Enumeration date
05/15/2008
Last updated
10/29/2014
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