Organization
RIVERTON MEMORIAL HOSPITAL LLC
Active
Other names
SageWest Health Care
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNETTA TRAYLOR (DIR LICENSE AND CERTIFICATION)
(502) 596-6063
Entity
Organization
Contact information
Practice address
1320 BISHOP RANDALL DR, LANDER, WY 82520-3939
(307) 332-4420
Mailing address
PO BOX 742744, ATLANTA, GA 30374-2744
(502) 212-8481
Taxonomy
Speciality
Code
Description
License number
State
282NR1301X
Rural Acute Care Hospital
Primary
05209
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007088
BCBS INPATIENT/OUTPATIENT
WY
01
—
00729001
BCBS PROFESSIONAL FEES
WY
05
—
114198800
—
WY
05
—
114198801
—
WY
Enumeration date
09/20/2006
Last updated
04/21/2026
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