Basic Information
| Provider Information | |||||||||
| NPI: | 1326152307 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALDRIDGE | ||||||||
| FirstName: | BEVERLY | ||||||||
| MiddleName: | S | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 99371 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761990371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828851855 | ||||||||
| FaxNumber: | 6828857347 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 7TH AVE | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761042733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828853199 | ||||||||
| FaxNumber: | 3828857499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 07/15/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | F9129 | TX | N | Allopathic & Osteopathic Physicians | Pediatrics | 208M00000X | F9129 | TX | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 107324100 | 01 | TX | FIRSTCARE PIN | OTHER | 1099696 | 01 | TX | UHC PIN | OTHER | 118009306 | 05 | TX | MEDICAID | 137345810 | 01 | TX | CSHCN GRP TPI | OTHER | 00U87Z | 01 | TX | MEDICARE GROUP PIN | OTHER | 413436 | 01 | TX | PHCS PIN | OTHER | 140442852 | 01 | TX | MEDICAID GRP TPI | OTHER | 1750369203 | 01 | GRP NPI NUMBER | OTHER | 10028685 | 01 | TX | AMERIGROUP PIN | OTHER | 4357321 | 01 | TX | AETNA PIN | OTHER | 5576468 | 01 | TX | CIGNA PIN | OTHER | 00U87Z | 01 | TX | BCBSTX GRP PIN | OTHER | 124024 | 01 | TX | SUPERIOR PIN | OTHER | 118009307 | 01 | TX | CSHCN | OTHER | 82V079 | 01 | TX | BCBSTX IND PIN | OTHER |