Healthcare Provider Details

I. General information

NPI: 1821290883
Provider Name (Legal Business Name): RIVERWOODS ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 RIVER PARK DR STE 195
PROVO UT
84604-6065
US

IV. Provider business mailing address

320 RIVER PARK DR STE 195
PROVO UT
84604-6065
US

V. Phone/Fax

Practice location:
  • Phone: 801-437-4500
  • Fax: 801-374-9195
Mailing address:
  • Phone: 801-437-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: CLARK S ASHBY
Title or Position: MEMBER
Credential: MD
Phone: 801-437-4500