Healthcare Provider Details

I. General information

NPI: 1255285086
Provider Name (Legal Business Name): RIVERTON GASTROENTEROLOGY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3741 W 12600 S STE 240
RIVERTON UT
84065-7215
US

IV. Provider business mailing address

3741 W 12600 S STE 240
RIVERTON UT
84065-7215
US

V. Phone/Fax

Practice location:
  • Phone: 904-631-7680
  • Fax:
Mailing address:
  • Phone: 904-631-7680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA HAMILTON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 904-631-7680