Basic Information
| Provider Information | |||||||||
| NPI: | 1134120165 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JOHN J FERRY MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7205 W CENTER RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029262425 | ||||||||
| FaxNumber: | 4029262435 | ||||||||
| Practice Location | |||||||||
| Address1: | 7205 W CENTER RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029262425 | ||||||||
| FaxNumber: | 4029262435 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2005 | ||||||||
| LastUpdateDate: | 02/03/2009 | ||||||||
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| AuthorizedOfficialLastName: | FERRY | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4029262425 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 19695 | IA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | 11256 | NE | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 3182329 | 01 | IOWA WELFARE | OTHER | I5480 | 01 | IOWA MEDICARE | OTHER | 275088 | 01 | NE | MEDICARE | OTHER | 100015959 | 01 | RR MEDICARE | OTHER |