MEDICARE: VARIETY CARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)		OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	CIGNA DENTAL	OTHER	OK	263715

General Provider Information

NPI Number	:	1275646143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VARIETY CARE, INC

Provider Business Mailing Address
First Line	:	3000 N GRAND BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-1818
Country	:	US
Telephone Number	:	405-632-6688
Fax Number	:	844-689-9671

Provider Business Practice Location Address
First Line	:	111 W MAIN ST
Second Line	:
City	:	FORT COBB
State	:	OK
Zip	:	73038-5866
Country	:	US
Telephone Number	:	405-632-6688
Fax Number	:	405-643-9296

Authorized Official
Title or Position	:	CFO
Name	:	TIM REDDOUT
Credential	:
Telephone Number	:	405-632-6688

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	02/26/2020

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Directions to “VARIETY CARE, INC ” Practice Location

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