Provider Demographics
NPI:1821290883
Name:RIVERWOODS ANESTHESIA PLLC
Entity Type:Organization
Organization Name:RIVERWOODS ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:ASHBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-437-4500
Mailing Address - Street 1:320 RIVER PARK DR STE 195
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:
Practice Address - Street 1:320 RIVER PARK DR STE 195
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:801-374-9195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000057933Medicare ID - Type Unspecified