Provider Demographics
NPI:1366806606
Name:VARIETY CHILDREN'S HOSPITAL
Entity type:Organization
Organization Name:VARIETY CHILDREN'S HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLORZANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-624-5767
Mailing Address - Street 1:3100 SW 62ND AVE
Mailing Address - Street 2:LIFEFLIGHT
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3100 SW 62ND AVE
Practice Address - Street 2:LIFEFLIGHT
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:786-624-5767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4007341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1255668331Medicaid
FLCW871AMedicaid
FL1598801847Medicaid
FL1255668331Medicaid
FL420006300Medicare PIN