MEDICARE: RIVERTON GASTROENTEROLOGY CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1255285086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERTON GASTROENTEROLOGY CENTER LLC

Provider Business Mailing Address
First Line	:	3741 W 12600 S STE 240
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84065-7215
Country	:	US
Telephone Number	:	904-631-7680
Fax Number	:

Provider Business Practice Location Address
First Line	:	3741 W 12600 S STE 240
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84065-7215
Country	:	US
Telephone Number	:	904-631-7680
Fax Number	:

Authorized Official
Title or Position	:	VP STRATEGIC PARTNERSHIPS
Name	:	JEREMY PETERS
Credential	:
Telephone Number	:	303-813-5160

Provider Enumeration Date	:	02/26/2026
Last Update Date	:	05/12/2026

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