DR. JACK BRIDGES (NPI# 1588639025) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588639025 |
| Entity Type | Individual |
| Full Name | DR. JACK BRIDGES |
| Credential | MD |
| Practice Address |
5325 Faraon St Saint Joseph MO 64506-3488 |
| Mailing Address |
3906 Oakland Ave, Box 8252 St Joseph MO 64508-7515 |
| Practice Telephone | 8162716575 |
| Practice Fax Number | 8162716139 |
| Mailing Telephone | 8162717648 |
| Enumeration Date | 2006-02-20 |
| Last Update Date | 2016-09-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
0427939 | KS | Allopathic & Osteopathic Physicians |
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
102182 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KS | 100287240B | 05 | |
| MO | 203612924 | 05 | |
| MO | BCBS OF KC MO | 24064048 | 01 |
| KS | BCBS KS FOR KS LOCATION | 106183 | 01 |
| BCBS KS FOR MO LOCATION | 470767 | 01 | |
| MO | RR MEDICARE GROUP CK7871 | 300138251 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558739896 | Jack Bridges | Physical Therapist | 24 Shiloh S, Cabot, AR 72023-2737 | 2015-09-03 |
| 1487965935 | Jack Weldon Bridges Iv | Hospitalist | 2000 Hospital Dr, Mt Pleasant, SC 29464 | 2010-06-30 |
| Street Address |
5325 FARAON ST |
| City | SAINT JOSEPH |
| State | MO |
| Zip Code | 64506-3488 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548261795 | Brian J Robb | Emergency Medicine | 5325 Faraon St, Saint Joseph, MO 64506-3488 | 2005-08-09 |
| 1154943991 | Claire Christine Gregson | Registered Nurse | 5325 Faraon St, Saint Joseph, MO 64506-3488 | 2020-05-14 |
| 1982239349 | Kaylee Messner | Nurse Practitioner | 5325 Faraon St, Saint Joseph, MO 64506-3488 | 2020-03-05 |
| 1760016554 | Nicole Elizabeth Cordonnier | Nurse Practitioner | 5325 Faraon St, Saint Joseph, MO 64506-3488 | 2020-03-02 |
| 1689211609 | Beulah Joshua | Family Medicine | 5325 Faraon St, Saint Joseph, MO 64506-3488 | 2019-12-09 |
| 1003452889 | Kevin Baer | Nurse Practitioner | 5325 Faraon St, Saint Joseph, MO 64506-3488 | 2019-11-27 |
| 1265076269 | Kia Whetstine | Nurse Practitioner | 5325 Faraon St, Saint Joseph, MO 64506-3488 | 2019-11-01 |
| 1962052001 | Brynde Janea Thomas | Nurse Practitioner | 5325 Faraon St, Saint Joseph, MO 64506-3488 | 2019-09-19 |
| 1073171039 | Rodger Alan Oren | Nurse Anesthetist, Certified Registered | 5325 Faraon St, Saint Joseph, MO 64506-3488 | 2019-06-04 |
| 1548828528 | Samantha Jo Shuey | Nurse Anesthetist, Certified Registered | 5325 Faraon St, Saint Joseph, MO 64506-3488 | 2019-06-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700484250 | Americare At Field Pointe LLC | Assisted Living Facility | 5002 Gene Field Road, St Joseph, MO 64506 | 2020-10-15 |
| 1669086609 | Phuc Vo | Pharmacist | 4022 N Belt Hyw, Saint Joseph, MO 64506 | 2020-09-08 |
| 1104450675 | Hughes Acupuncture LLC | Acupuncturist | 1918 North Belt Highway, St Joseph, MO 64506 | 2020-02-24 |
| 1306323316 | Camilla Allison Walling | Nurse Practitioner | 1009 West St. Maartens Drive Suite F, Saint Joseph, MO 64506 | 2018-07-23 |
| 1326559964 | Amber Wheatley Wood | Counselor | 724 N. 22nd Street, Saint Joseph, MO 64506 | 2017-10-23 |
| 1366952988 | Annette Burris | Audiologist | 2401 North Woodbine, St. Joseph, MO 64506 | 2017-10-10 |
| 1962927665 | Genuine Senior Care LLC | In Home Supportive Care | 3715 Beck Road, Suite 207b, St. Joseph, MO 64506 | 2017-08-03 |
| 1215396569 | Andrew M Fisher | Counselor | 2400 Frederick Blvd, Suite 407, Saint Joseph, MO 64506 | 2016-02-15 |
| 1699133678 | Missouri Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 3320 North Belt Highway, St Joseph, MO 64506 | 2016-02-04 |
| 1598167587 | Quality Hearing and Audiology Center LLC | Audiologist | 2227 North Belt Highway, St. Joseph, MO 64506 | 2014-09-22 |
| Find all providers in zip 64506 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891119913 | Scott Rossow, Do, PC | Radiology | 2209 Ashland Ave, Saint Joseph, MO 64506-1932 | 2014-02-10 |
| 1144599143 | Robert Lackamp, Md, PC | Radiology | 606 N Leonard Rd, Saint Joseph, MO 64506-4025 | 2011-12-20 |
| 1710947908 | Advanced Diagnostic Imaging LLC | Radiology | 3620 Frederick Ave, Saint Joseph, MO 64506-3047 | 2006-03-23 |
| 1023087616 | Mobile Medical Services Inc | Radiology | 3622 Charles St, Saint Joseph, MO 64506-3424 | 2006-03-16 |
| 1851398713 | Kenneth E Mann | Radiology | 3937 Sherman Ave, Saint Joseph, MO 64506-3649 | 2005-07-06 |
| 1265775910 | American Diagnostic Imaging Inc | Radiology | 3937 Sherman Ave, Saint Joseph, MO 64506-3649 | 2013-04-01 |
| 1437493376 | American Diagnostic Imaging LLC | Radiology | 3937 Sherman Ave, Saint Joseph, MO 64506-3649 | 2012-11-15 |
| 1811120280 | Mann Radiology PC | Radiology | 3937 Sherman Ave, Saint Joseph, MO 64506-3649 | 2009-09-01 |
| 1679711014 | East Ridge Investments LLC | Radiology | 3937 Sherman Ave, Suite B, Saint Joseph, MO 64506-3649 | 2009-01-22 |
| 1881859627 | Heartland Regional Medical Center | Radiology | 802 N Riverside Rd, Ste 150, Saint Joseph, MO 64507-2502 | 2008-07-22 |
| Find all providers in SAINT JOSEPH | ||||
| City | SAINT JOSEPH |
| Zip Code | 64506 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.