Healthcare Provider Details

I. General information

NPI: 1245337286
Provider Name (Legal Business Name): RIVERTON MEMORIAL HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 BISHOP RANDALL DR
LANDER WY
82520-3939
US

IV. Provider business mailing address

PO BOX 742744
ATLANTA GA
30374-2744
US

V. Phone/Fax

Practice location:
  • Phone: 307-332-4420
  • Fax:
Mailing address:
  • Phone:
  • Fax: 502-212-8481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number05209
License Number StateWY

VIII. Authorized Official

Name: JOHNETTA TRAYLOR
Title or Position: DIR LICENSE AND CERTIFICATION
Credential:
Phone: 502-596-6063