NPIMap

Individual provider Active NPI

Johnathan Parker Tadlock, DO

  • Emergency Medicine Physician
  • Lawton, OK
National Provider Identifier
1427807155
Registry record updated Aug 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
9196 Issued in OK
Practice address
3401 W Gore Blvd
Lawton, OK 73505-6332
Phone
(580) 585-5545
NPI assigned
May 15, 2024
Last updated
Aug 8, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 9196 OK Primary

Addresses

Primary practice location

3401 W Gore Blvd
Lawton, OK 73505-6332

Mailing address

3401 W Gore Blvd
Lawton, OK 73505-6332
Phone (580) 585-5545

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250712000316 OK Practitioner - Emergency Medicine 1759896491 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Kansas City University of Med & Biosciences, College of Osteo Med, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency Physicians of Mid-America PCGroup PAC ID 2062638661, 86 clinicians
Jackson County Memorial Hospital AuthorityGroup PAC ID 1759293178, shared by 9 NPIs, 46 clinicians

Practice addresses (Care Compare)

1500 N Green Ave
Purcell, OK 73080-1642
Phone (405) 527-6524

205 S Park LN
Suite 210
Altus, OK 73521-5757
Phone (580) 379-6650

400 E Chestnut St
Hollis, OK 73550-2030
Phone (580) 688-3363

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
9196OKMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians of Mid-America, P.C. Emergency Medicine CurrentSince Aug 1, 2025 Accepting new patients
Jackson County Memorial Hospital Authority CurrentSince Feb 23, 2026 Accepting new patients
Jackson County Memorial Hospital Authority CurrentSince Feb 23, 2026 Accepting new patients
Arbuckle Memorial Hospital CurrentSince Sep 10, 2025 Accepting new patients
Arbuckle Memorial Hospital CurrentSince Sep 10, 2025 Accepting new patients

Locations

1200 E Pecan St
Altus, OK 73521
Phone (580) 379-5000

205 S Park Ln
Ste 210
Altus, OK 73521
Phone (580) 379-6650

400 E Chestnut St
Hollis, OK 73550
Phone (580) 471-0971

3401 W Gore Blvd
Lawton, OK 73505
Phone (580) 483-5207

1500 N Green Ave
Purcell, OK 73080
Phone (405) 527-2250

2401 W Wrangler Blvd
Seminole, OK 74868
Phone (405) 303-4000

1102 W MacArthur St
Shawnee, OK 74804
Phone (405) 273-2270

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1715731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754611200000",
    "number": "1427807155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 W GORE BLVD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735056332",
            "telephone_number": "580-585-5545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 W GORE BLVD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735056332",
            "telephone_number": "580-585-5545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TADLOCK",
        "first_name": "JOHNATHAN",
        "middle_name": "PARKER",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-15",
        "last_updated": "2025-08-08",
        "certification_date": "2025-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OK",
            "license": "9196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawton, OK

Sources for this page

Verify at the official NPI Registry.