Provider Demographics
NPI:1134120165
Name:JOHN J FERRY MD PC
Entity Type:Organization
Organization Name:JOHN J FERRY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-926-2425
Mailing Address - Street 1:7205 W CENTER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124
Mailing Address - Country:US
Mailing Address - Phone:402-926-2425
Mailing Address - Fax:402-926-2435
Practice Address - Street 1:7205 W CENTER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124
Practice Address - Country:US
Practice Address - Phone:402-926-2425
Practice Address - Fax:402-926-2435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-01
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11256207RG0100X
IA19695207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3182329OtherIOWA WELFARE
I5480OtherIOWA MEDICARE
NE275088OtherMEDICARE
100015959OtherRR MEDICARE
NE=========00Medicaid
I5480OtherIOWA MEDICARE