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NPI Code Detail

MEDICARE: ERNEST C SEVERN DO

MEDICARE: ERNEST C SEVERN DO
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
1207Q00000XFamily Medicine Physician8262575-1204UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18S0440OTHERTXBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326080847
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERNEST C SEVERN DO
Provider Business Mailing Address
First Line : 1756 W PARK AVE
Second Line :
City : RIVERTON
State : UT
Zip : 84065-4701
Country : US
Telephone Number : 801-254-0309
Fax Number : 801-254-1012
Provider Business Practice Location Address
First Line : 1756 W PARK AVE
Second Line :
City : RIVERTON
State : UT
Zip : 84065-4701
Country : US
Telephone Number : 801-254-0309
Fax Number : 801-254-1012
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2006
Last Update Date : 12/05/2020

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Directions to “ ERNEST C SEVERN DO” Practice Location

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