1033344197 NPI number — VARIETY CARE, INC

Table of content: (NPI 1033344197)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033344197 NPI number — VARIETY CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VARIETY CARE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033344197
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3000 N GRAND BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73107-1818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-632-6688
Provider Business Mailing Address Fax Number:
405-604-0708

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4023 NW 10TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73107-6038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-632-6688
Provider Business Practice Location Address Fax Number:
405-604-0708
Provider Enumeration Date:
05/19/2009

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100734110N , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 371855 . This is a "MEDICARE PTAN" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com