Provider Demographics
NPI:1083086706
Name:VARIETY CARE, INC.
Entity type:Organization
Organization Name:VARIETY CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-632-6688
Mailing Address - Street 1:3000 N GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-1818
Mailing Address - Country:US
Mailing Address - Phone:405-632-6688
Mailing Address - Fax:844-689-9671
Practice Address - Street 1:2208 W HEFNER RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-7618
Practice Address - Country:US
Practice Address - Phone:405-632-6688
Practice Address - Fax:844-689-9671
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VARIETY CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-21
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty