Organization
RIVERTON MEMORIAL HOSPITAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD J. BIVACCA (PRESIDENT)
(615) 372-8500
Entity
Organization
Contact information
Practice address
2100 W SUNSET DR, RIVERTON, WY 82501-2274
(307) 856-4361
(307) 857-3571
Mailing address
103 POWELL CT, BRENTWOOD, TN 37027-5079
(615) 372-8500
(615) 372-8572
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
208600000X
Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00729001
BCBS
—
05
—
114198801
—
WY
Enumeration date
02/02/2007
Last updated
10/03/2013
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