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General NPI Number Information
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NPI Number | 1598849440
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Entity Type | Organization
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Legal Business Name | MERYL A SEVERSON MD
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4610 DODGE ST
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City | OMAHA
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State | NE
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Zip | 68132-3234
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Country | US
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Telephone | 402-306-8056
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Fax | 402-554-1805
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Provider Business Mailing Address
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Address Line | 4610 DODGE ST
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City | OMAHA
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State | NE
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Zip | 68132-3234
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Country | US
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Telephone | 402-306-8056
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Fax | 402-554-1805
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Authorized Official
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Title or Position | VP MEDICAL SERVICES
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Name | MRS. LINDA BEIRIGER
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Credential | MBA
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Telephone | 402-554-1103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 24963
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 19357
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License Number State | NE
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