MEDICARE: CHARLES ALLEN SEVER PA-C

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	363A00000X	Physician Assistant	PA07352	TX
2	363AM0700X	Medical Physician Assistant	1702	WI
3	363A00000X	Physician Assistant	2912	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00623891	OTHER	WI	RAIL ROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1952306847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES ALLEN SEVER PA-C

Provider Business Mailing Address
First Line	:	200 S ACADEMY RD
Second Line	:
City	:	GUTHRIE
State	:	OK
Zip	:	73044-8727
Country	:	US
Telephone Number	:	405-282-6700
Fax Number	:	405-282-4826

Provider Business Practice Location Address
First Line	:	200 S ACADEMY RD
Second Line	:
City	:	GUTHRIE
State	:	OK
Zip	:	73044
Country	:	US
Telephone Number	:	405-282-6700
Fax Number	:	405-282-4826

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	08/22/2018

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Directions to “ CHARLES ALLEN SEVER PA-C” Practice Location

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