Provider Demographics
NPI:1801894035
Name:RIVERWOODS URGENT CARE CENTER LC
Entity type:Organization
Organization Name:RIVERWOODS URGENT CARE CENTER LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-229-2011
Mailing Address - Street 1:280 WEST RIVER PARK DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5796
Mailing Address - Country:US
Mailing Address - Phone:801-229-2011
Mailing Address - Fax:801-224-0242
Practice Address - Street 1:280 WEST RIVER PARK DR
Practice Address - Street 2:SUITE 120
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-5796
Practice Address - Country:US
Practice Address - Phone:801-229-2011
Practice Address - Fax:801-224-0242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT44244207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5421450001Medicare NSC
UT000057844Medicare PIN