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: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W SUNSET DR
RIVERTON WY
82501-2274
US

IV. Provider business mailing address

680 S 4TH ST
LOUISVILLE KY
40202-2407
US

V. Phone/Fax

Practice location:
  • Phone: 307-856-4161
  • Fax: 307-857-3571
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