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General NPI Number Information
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NPI Number | 1245337286
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Entity Type | Organization
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Legal Business Name | RIVERTON MEMORIAL HOSPITAL LLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 2100 W SUNSET DR
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City | RIVERTON
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State | WY
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Zip | 82501-2274
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Country | US
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Telephone | 307-856-4161
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Fax | 307-857-3571
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Provider Business Mailing Address
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Address Line | 680 S 4TH ST
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City | LOUISVILLE
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State | KY
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Zip | 40202-2407
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Country | US
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Telephone |
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Fax | 502-212-8481
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Authorized Official
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Title or Position | DIR LICENSE AND CERTIFICATION
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Name | JOHNETTA TRAYLOR
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Credential |
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Telephone | 502-596-6063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NR1301X
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Taxonomy Name | Rural Acute Care Hospital
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License Number | 05209
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License Number State | WY
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