Provider Demographics
NPI:1598849440
Name:MERYL A SEVERSON MD
Entity Type:Organization
Organization Name:MERYL A SEVERSON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP MEDICAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEIRIGER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:402-554-1103
Mailing Address - Street 1:4610 DODGE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-3234
Mailing Address - Country:US
Mailing Address - Phone:402-306-8056
Mailing Address - Fax:402-554-1805
Practice Address - Street 1:4610 DODGE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-3234
Practice Address - Country:US
Practice Address - Phone:402-306-8056
Practice Address - Fax:402-554-1805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19357207VG0400X
IA24963207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0228676Medicaid
KS20 50893401Medicaid
NE47-151703903Medicaid
IA228676Medicare ID - Type UnspecifiedPHYSICIAN
IA0228676Medicaid