NPIMap

Organization Active NPI

Variety Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Clinton, OK
National Provider Identifier
1275355299
Registry record updated Oct 30, 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.
Practice address
316 S 4TH St
Clinton, OK 73061
Phone
(405) 632-6688
NPI assigned
Oct 30, 2024
Organization subpart
Yes
Parent organization
VARIETY CARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 30, 2024

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

Authorized official

Name
Nadine M Davidson
Title
Revenue Cycle Management Director
Phone
(405) 632-6688

Specialties & licenses 1

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

Addresses

Primary practice location

316 S 4TH St
Clinton, OK 73061

Mailing address

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

Other names 1

  • Variety Care Clinton 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…
O20250919001817 OK Part A Provider - Federally Qualified Health Center (FQHC) 1557260007 Practice locations: Clinton, OK

Federally qualified health center certification: CCN 371057

Legal name
VARIETY CARE, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 5, 2025
Last certification
Sep 5, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
316 S 4TH St
Clinton, OK 73601-4114

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
37D2315617Variety Care Clinton316 S 4TH St, Clinton, OK 73601Certificate of waiverDec 16, 2026

National Provider Directory

National Provider Directory
Tax ID family
Variety Care Inc26 organizations share this tax ID, including this one
Part of
Variety Care Inc

Other organizations with this tax ID 25

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

View all 25

Ownership & related parties

All disclosed owners & managing parties 9

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 Other Aug 1, 2017
Louise R Carmichael Individual Operational/Managerial ControlCeo Dec 1, 2004
Ana Deisy Escalera Individual Other Dec 1, 2020
Leslie Warrior Individual Other Mar 1, 2017
Jared Deck Individual Other Aug 1, 2017
Jason Pledger Individual Other Jul 1, 2018
Timothy Reddout Individual Operational/Managerial ControlVice President Jun 16, 2025
Nadine Davidson Individual Operational/Managerial ControlRevenue Cycle Management Director Jun 15, 2025
Donald Nevard Individual Other Jun 1, 2022

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1730246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730246400000",
    "number": "1275355299",
    "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": "316 S 4TH ST",
            "city": "CLINTON",
            "state": "OK",
            "postal_code": "73061",
            "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": "2024-10-30",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-22",
        "status": "A",
        "authorized_official_last_name": "DAVIDSON",
        "authorized_official_first_name": "NADINE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGEMENT DIRECTOR",
        "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 Clinton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clinton, OK

Sources for this page

Verify at the official NPI Registry.