MEDICARE: SEVERSON LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372600000X	Adult Companion

General Provider Information

NPI Number	:	1114499837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEVERSON LLC

Provider Business Mailing Address
First Line	:	PO BOX 210101
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99521-0101
Country	:	US
Telephone Number	:	907-222-1153
Fax Number	:

Provider Business Practice Location Address
First Line	:	8531 LITTLE DIPPER AVE
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99504-4238
Country	:	US
Telephone Number	:	907-317-5050
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. TODD LEE SEVERSON
Credential	:
Telephone Number	:	907-222-1153

Provider Enumeration Date	:	12/19/2018
Last Update Date	:	12/19/2018

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Directions to “SEVERSON LLC ” Practice Location

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