NPIMap

Organization Active NPI

Variety Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Oklahoma City, OK
National Provider Identifier
1033344197
Registry record updated Feb 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
VARIETY CARE, INC
Practice address
4023 NW 10TH St
Oklahoma City, OK 73107-6038
Phone
(405) 632-6688
Fax
(405) 604-0708
NPI assigned
May 19, 2009
Organization subpart
Yes
Parent organization
VARIETY CARE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 26, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tim Reddout
Title
Cfo
Phone
(405) 632-6688

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

4023 NW 10TH St
Oklahoma City, OK 73107-6038

Mailing address

3000 N Grand Blvd
Oklahoma City, OK 73107-1818
Phone (405) 632-6688

Other identifiers 2

IdentifierTypeStateIssuer
100734110NMedicaidOK
371855OtherOKMEDICARE PTAN

Other names 1

  • Variety Care 10th Street Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040105000467 OK Part B Supplier - Clinic/Group Practice 1557260007 Receives reassigned benefits from 135 practitioners
26 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clinton, OK; Anadarko, OK; Yukon, OK; Oklahoma City, OK; Del City, OK; Edmond, OK; Fort Cobb, OK; Grandfield, OK…
O20090629000443 OK Part A Provider - Federally Qualified Health Center (FQHC) 1557260007 Practice locations: Oklahoma City, OK

Federally qualified health center certification: CCN 371855

Legal name
VARIETY CARE, INC.
Doing business as
VARIETY CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 31, 2009
Last certification
Jul 31, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 12, 1997 in OK
Enrollment address
4023 NW 10TH Street
Variety Care
Oklahoma City, OK 73107-1818

Other NPIs with the same Medicare PAC ID 22

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 22

Other NPIs on the same Medicare enrollment 26

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 26

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D1099768Variety Care NW 10TH4023 NW 10TH St, Oklahoma City, OK 73107Provider-performed microscopyMay 19, 2027

National Provider Directory

National Provider Directory
Part of
Variety Care Inc

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Mariano Acuna Individual Corporate OfficerBoard Member Jul 1, 2019
Rachel Ramirez Individual Corporate OfficerBoard Member Aug 1, 2017
Louise R Carmichael Individual Operational/Managerial ControlCeo Jul 1, 2009
Ashley Horn Individual Corporate OfficerComptroller Nov 1, 2019
Corporate DirectorComptroler Nov 1, 2019
Mary Ann Martin Individual Corporate OfficerSecretary Jul 1, 2019
Leslie Warrior Individual Corporate OfficerBoard Member Aug 1, 2017
Jared Deck Individual Corporate OfficerTreasurer Jul 1, 2019
Timothy Reddout Individual Corporate OfficerCfo Nov 1, 2019
Corporate DirectorCfo Nov 1, 2019
Donald Nevard Individual Corporate OfficerBoard Member Jul 1, 2019
Amy Dunn Individual Corporate OfficerPresident Jul 1, 2019

Practitioners & affiliated clinicians

Practitioners 105

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 105

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582675200000",
    "number": "1033344197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 N GRAND BLVD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731071818",
            "telephone_number": "405-632-6688",
            "fax_number": "405-604-0708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4023 NW 10TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731076038",
            "telephone_number": "405-632-6688",
            "fax_number": "405-604-0708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VARIETY CARE, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VARIETY CARE INC",
        "enumeration_date": "2009-05-19",
        "last_updated": "2020-02-26",
        "certification_date": "2020-02-26",
        "status": "A",
        "authorized_official_last_name": "REDDOUT",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "405-632-6688"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100734110N",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "371855",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Variety Care 10th Street",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Variety Care 10th Street",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.