Healthcare Provider Details

I. General information

NPI: 1336527928
Provider Name (Legal Business Name): VARIETY CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W 1ST ST
GRANDFIELD OK
73546-9236
US

IV. Provider business mailing address

3000 N GRAND BLVD
OKLAHOMA CITY OK
73107-1818
US

V. Phone/Fax

Practice location:
  • Phone: 405-632-6688
  • Fax: 580-479-3245
Mailing address:
  • Phone: 405-632-6688
  • Fax: 405-604-0708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: TIM REDDOUT
Title or Position: CFO
Credential:
Phone: 405-632-6688