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Organization

RIVERWOODS INTERVENTIONAL RADIOLOGY INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
WENDELL A GIBBY MD (OWNER)
(801) 437-4895
Entity
Organization

Contact information

Practice address
3152 N UNIVERSITY AVE, SUITE 150, PROVO, UT 84604-4729
(801) 437-4895
(801) 229-1003
Mailing address
3152 N UNIVERSITY AVE, SUITE 150, PROVO, UT 84604-4729
(801) 437-4895
(801) 229-1003

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
5414031-1704
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
528906826089
UT
Enumeration date
10/02/2006
Last updated
10/27/2011
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