Provider Demographics
NPI:1538100649
Name:RIVERWOODS SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:RIVERWOODS SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLI
Authorized Official - Middle Name:
Authorized Official - Last Name:CRISP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-437-4500
Mailing Address - Street 1:320 RIVER PARK DR STE 125
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-6065
Mailing Address - Country:US
Mailing Address - Phone:801-437-4500
Mailing Address - Fax:801-437-1400
Practice Address - Street 1:320 RIVER PARK DR STE 125
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6065
Practice Address - Country:US
Practice Address - Phone:801-437-4500
Practice Address - Fax:801-437-1400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2005ASF70230261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT20057023000001OtherBCBS
UT920829OtherDMBA
UT103015041101OtherIHC
UT268010OtherALTIUS
UT34980OtherHEALTHY U
UT46C0001042Medicare PIN
UT920829OtherDMBA