NPIMap

Organization Active NPI

Variety Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Oklahoma City, OK
National Provider Identifier
1972056372
Registry record updated May 12, 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
4000 W Reno Ave
Oklahoma City, OK 73107-6632
Phone
(405) 632-6688
Fax
(405) 601-2684
NPI assigned
Aug 2, 2016
Organization subpart
Yes
Parent organization
VARIETY CARE, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 12, 2020

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

Authorized official

Name
Tim Reddout, CFO
Title
Chief Financial Officer
Phone
(405) 632-6688

Specialties & licenses 1

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

Addresses

Primary practice location

4000 W Reno Ave
Oklahoma City, OK 73107-6632

Mailing address

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

Other names 1

  • Variety Care Reno 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…
O20161012000610 OK Part A Provider - Federally Qualified Health Center (FQHC) 1557260007 Practice locations: Oklahoma City, OK

Federally qualified health center certification: CCN 371922

Legal name
VARIETY CARE, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 12, 2016
Last certification
Oct 12, 2016
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Jan 17, 1980 in OK
Enrollment address
4000 W Reno Ave
Oklahoma City, OK 73107-6632

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
37D2117725Variety Care Reno4000 W Reno Ave, Oklahoma City, OK 73107Provider-performed microscopyAug 22, 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 DirectorBoard Member Jul 1, 2019
Rachel Ramirez Individual Corporate DirectorBoard Member Jul 1, 2019
Louise R Carmichael Individual Corporate OfficerCeo Aug 1, 2016 100%
Ashley Horn Individual Corporate OfficerComptroller Nov 1, 2019
Corporate DirectorComptroler Nov 1, 2019
W-2 Managing EmployeeComptroller 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 DirectorBoard Member Jul 1, 2019
Amy Dunn Individual Corporate OfficerPresident Jul 1, 2019

Practitioners & affiliated clinicians

Practitioners 9

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": "1470096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589241600000",
    "number": "1972056372",
    "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": "4000 W RENO AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731076632",
            "telephone_number": "405-632-6688",
            "fax_number": "405-601-2684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VARIETY CARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VARIETY CARE, INC",
        "enumeration_date": "2016-08-02",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A",
        "authorized_official_last_name": "REDDOUT",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "405-632-6688",
        "authorized_official_credential": "CFO"
    },
    "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 Reno",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.