Jack Stephen Aldridge, D.O.
Individual provider Active NPI Family Medicine Physician · Coweta, OK
NPI 1700878378 · NPPES record last updated Jul 31, 2015
Key facts
- NPI
- 1700878378
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- OK2679 (OK)
- Practice address
- 30011 E State Highway 51
Coweta, OK 74429-7681 - Phone
- (918) 486-2161
- Fax
- (918) 486-3135
- NPI assigned
- Aug 18, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OK2679 | OK | MD | Family Medicine Physician |
| 2679 | OK | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northeastern State University College of Optometry | Past | Accepting new patients | |
| Ahs Henryetta Hospital LLC | Past | Accepting new patients | |
| Ahs Oklahoma Physician Group LLC | Family Medicine | Past | Accepting new patients |
| Claremore Physicians LLC | Past | Accepting new patients | |
| Cherokee Nation | Past |
Accepting new patients | |
| Cherokee Nation | Past | Accepting new patients |
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/2d405cde-1d8b-4a50-adff-ca7776cd856e/
- https://epicproxy.ardenthealth.com/fhir/UPC/api/FHIR/R4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OK2679 | OK | Yes |
Addresses
Primary practice location
30011 E State Highway 51
Coweta, OK 74429-7681
Mailing address
6600 S Yale Ave
Suite 1400
Tulsa, OK 74136-3347
Phone (918) 488-6001
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100099700A | Medicaid | OK | |
| 500522075 | Other | OK | MEDICARE GROUP PIN |
Other providers in Coweta, OK
- A Place Close to Home Adult Day Care
- Abs Foundations ABA Specialists LLC
- Advanced Family Eye Care Inc
- Bilal Ahmed
- Allen S Braumiller Jr DDS PC
- Bradley Todd Anderson
- Kyle A Anderson
- Arkansas Verdigris Valley Health Centers, Inc.
- Kylee Nicole Armstrong
All providers in Coweta, OK · Family Medicine Physician in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 31, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.