Provider Demographics
NPI:1598786105
Name:TEDDY BEAR OBSTETRICS & GYNECOLOGY PS
Entity Type:Organization
Organization Name:TEDDY BEAR OBSTETRICS & GYNECOLOGY PS
Other - Org Name:JOHN C. PERRY, M.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-582-0400
Mailing Address - Street 1:711 S AUBURN ST
Mailing Address - Street 2:SUITE P
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-5665
Mailing Address - Country:US
Mailing Address - Phone:509-582-0400
Mailing Address - Fax:509-582-0408
Practice Address - Street 1:711 S AUBURN ST
Practice Address - Street 2:SUITE P
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5665
Practice Address - Country:US
Practice Address - Phone:509-582-0400
Practice Address - Fax:509-582-0408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00025747207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1301241Medicaid
WA7126899Medicaid
WA8852831Medicare ID - Type UnspecifiedDR. PERRY'S MEDICARE
WA1301241Medicaid
WA7126899Medicaid
WAI29507Medicare UPIN