Provider Demographics
NPI:1497982805
Name:RIVERTON PHYSICIAN PRACTICES LLC
Entity Type:Organization
Organization Name:RIVERTON PHYSICIAN PRACTICES LLC
Other - Org Name:WIND RIVER ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BIVACCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:1005 COLLEGE VIEW DR
Mailing Address - Street 2:SUITE 9
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-2266
Mailing Address - Country:US
Mailing Address - Phone:370-857-3488
Mailing Address - Fax:370-857-5215
Practice Address - Street 1:1005 COLLEGE VIEW DR
Practice Address - Street 2:SUITE 9
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2266
Practice Address - Country:US
Practice Address - Phone:370-857-3488
Practice Address - Fax:370-857-5215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty