Provider Demographics
NPI:1659995116
Name:VARIETY CARE, INC.
Entity Type:Organization
Organization Name:VARIETY CARE, INC.
Other - Org Name:VARIETY CARE YUKON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP & CFO
Authorized Official - Prefix:MR
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 1:508 W VANDAMENT AVE STE 210
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4666
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:2020-06-01
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)