NPIMap

Organization Active NPI

Variety Care, Inc

Doing business as Variety Care Fort Cobb

  • Federally Qualified Health Center (FQHC)
  • Fort Cobb, OK
National Provider Identifier
1275646143
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
Doing business as
Variety Care Fort Cobb
Practice address
111 W Main St
Fort Cobb, OK 73038-5866
Phone
(405) 632-6688
Fax
(405) 643-9296
NPI assigned
Aug 16, 2006
Last updated
Feb 26, 2020By the provider in NPPES
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 OK Primary

Addresses

Primary practice location

111 W Main St
Fort Cobb, OK 73038-5866

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
CIGNA DENTALOtherOK263715
100734110IMedicaidOK

Other names 1

  • Variety Care Fort Cobb 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…
O20041221000840 OK Part A Provider - Federally Qualified Health Center (FQHC) 1557260007 Practice locations: Fort Cobb, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1275646143. Details of each certification follow.

Federally qualified health center certification: CCN 371829

Legal name
VARIETY CARE, INC.
Doing business as
VARIETY CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 10, 2002
Last certification
Jul 10, 2002
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 8, 1980 in OK
Enrollment address
111 W Main St
Fort Cobb, OK 73038-5863
Related CCNs
371820

Facilities connected through Provider of Services related, parent or unit certification numbers.

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
37D0992425Variety Care Fort Cobb111 W Main Street, Fort Cobb, OK 73038Provider-performed microscopyAug 15, 2027

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

Locations

111 W Main St
Fort Cobb, OK 73038

4023 NW 10th St
Oklahoma City, OK 73107

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 DirectorBoard Member Jan 1, 2015
Rachel Ramirez Individual Corporate DirectorBoard Member Jul 1, 2019
Louise R Carmichael Individual Corporate OfficerCeo Dec 1, 2004 100%
Corporate Director Dec 21, 2004
W-2 Managing Employee Dec 21, 2004
Ashley Horn Individual Corporate OfficerComptroller Nov 1, 2019
Corporate DirectorComptroler Nov 1, 2019
Mary Ann Martin Individual Corporate DirectorSecretary Jan 1, 2015
Leslie Warrior Individual Corporate DirectorBoard Member Jul 1, 2019
Jared Deck Individual Corporate DirectorTreasurer Jan 1, 2015
Timothy Reddout Individual Corporate OfficerCfo Nov 1, 2019
Corporate DirectorCfo Nov 1, 2019
Donald Nevard Individual Corporate OfficerBoard Member Jan 1, 2015
Amy Dunn Individual Corporate OfficerPresident Jan 1, 2015

Practitioners & affiliated clinicians

Practitioners 6

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": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582675200000",
    "number": "1275646143",
    "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": "844-689-9671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 W MAIN ST",
            "city": "FORT COBB",
            "state": "OK",
            "postal_code": "730385866",
            "telephone_number": "405-632-6688",
            "fax_number": "405-643-9296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VARIETY CARE, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VARIETY CARE, INC",
        "enumeration_date": "2006-08-16",
        "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": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "263715",
            "identifier": "CIGNA DENTAL",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100734110I",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Variety Care Fort Cobb",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Variety Care Fort Cobb",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Cobb, OK

Sources for this page

Verify at the official NPI Registry.