NPIMap

Organization Active NPI

Variety Care, Inc.

Doing business as Variety Care at Pete White Health and Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Oklahoma City, OK
National Provider Identifier
1770826661
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 at Pete White Health and Wellness Center
Practice address
4021 S Walker Ave Ste 201
Oklahoma City, OK 73109-6972
Phone
(405) 632-6688
Fax
(405) 595-3247
NPI assigned
Mar 29, 2013
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 Primary

Addresses

Primary practice location

4021 S Walker Ave Ste 201
Oklahoma City, OK 73109-6972

Mailing address

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

Other names 1

  • Variety Care at Pete White Health and Wellness Center 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…
O20130912000234 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 1770826661. Details of each certification follow.

Federally qualified health center certification: CCN 371891

Legal name
VARIETY CARE, INC.
Doing business as
VARIETY CARE AT PETE WHITE HEALTH AND WELLNESS CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 12, 2013
Last certification
Sep 12, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 12, 1997 in OK
Enrollment address
4021 S Walker Ave
Ste 201
Oklahoma City, OK 73109-6972

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
37D2060474Variety Care Pete White4021 S Walker Ave, Ste 201, Oklahoma City, OK 73109Provider-performed microscopyOct 31, 2026

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 Jun 8, 2009
Rachel Ramirez Individual Corporate DirectorBoard Member Jul 1, 2019
Louise R Carmichael Individual Corporate DirectorCeo Jul 1, 2006
W-2 Managing Employee Apr 1, 2013
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 DirectorBoard Member Jul 1, 2019
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 Sep 5, 2008
Amy Dunn Individual Corporate OfficerPresident Apr 24, 2006

Practitioners & affiliated clinicians

Practitioners 5

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": "1364515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582675200000",
    "number": "1770826661",
    "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": "4021 S WALKER AVE STE 201",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731096972",
            "telephone_number": "405-632-6688",
            "fax_number": "405-595-3247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VARIETY CARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VARIETY CARE, INC",
        "enumeration_date": "2013-03-29",
        "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Variety Care at Pete White Health and Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.