Healthcare Provider Details

I. General information

NPI: 1528055431
Provider Name (Legal Business Name): RIVERTON FAMILY HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1756 PARK AVE
RIVERTON UT
84065-4701
US

IV. Provider business mailing address

1756 PARK AVE
RIVERTON UT
84065-4701
US

V. Phone/Fax

Practice location:
  • Phone: 801-254-0309
  • Fax: 801-254-1012
Mailing address:
  • Phone: 801-254-0309
  • Fax: 801-254-1012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23511
License Number StateUT

VIII. Authorized Official

Name: AARON C MONSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 801-254-0309