NPIMap

Organization Active NPI

Variety Care, Inc.

Doing business as Variety Care Crooked Oak

  • Federally Qualified Health Center (FQHC)
  • Oklahoma City, OK
National Provider Identifier
1104696657
Registry record updated Jan 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
VARIETY CARE, INC.
Doing business as
Variety Care Crooked Oak
Practice address
1450 S Eastern Ave BLDG a
Oklahoma City, OK 73129-6035
Phone
(405) 632-6688
NPI assigned
Jan 5, 2024
Last updated
Jan 5, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
VARIETY CARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 5, 2024

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

Authorized official

Name
Ashley Horn
Title
Comptroller
Phone
(405) 632-6688

Specialties & licenses 1

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

Addresses

Primary practice location

1450 S Eastern Ave BLDG a
Oklahoma City, OK 73129-6035

Mailing address

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

Other names 1

  • Variety Care Crooked Oak 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…
O20240914000186 OK Part A Provider - Federally Qualified Health Center (FQHC) 1557260007 Practice locations: Oklahoma City, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104696657. Details of each certification follow.

Federally qualified health center certification: CCN 371039

Legal name
VARIETY CARE, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 8, 2024
Last certification
Aug 8, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 17, 1980 in OK
Enrollment address
1450 S Eastern Ave
BLDG a
Oklahoma City, OK 73129-6035

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
37D2298676Variety Care Crooked Oak1450 S Eastern Ave, BLDG a, Oklahoma City, OK 73129Provider-performed microscopyFeb 5, 2028

National Provider Directory

National Provider Directory
Tax ID family
Variety Care Inc27 organizations share this tax ID, including this one
Part of
Variety Care Inc

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Louise R Carmichael Individual Operational/Managerial ControlCeo Dec 1, 2004
Ashley Horn Individual Operational/Managerial ControlComptroller Nov 1, 2019
Mary Ann Martin Individual Corporate OfficerSecretary Aug 1, 2017
Leslie Warrior Individual Corporate OfficerBoard Secretary Aug 1, 2017
Jared Deck Individual Corporate OfficerTreasurer Aug 1, 2017
Timothy Reddout Individual Operational/Managerial ControlVP & Cfo Nov 1, 2019
Donald Nevard Individual Corporate OfficerBoard Member Aug 1, 2017
Amy Dunn Individual Corporate OfficerPresident Aug 1, 2017

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1704412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704412800000",
    "number": "1104696657",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 S EASTERN AVE BLDG A",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731296035",
            "telephone_number": "405-632-6688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VARIETY CARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VARIETY CARE, INC.",
        "enumeration_date": "2024-01-05",
        "last_updated": "2024-01-05",
        "certification_date": "2024-01-05",
        "status": "A",
        "authorized_official_last_name": "HORN",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "COMPTROLLER",
        "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Variety Care Crooked Oak",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.