MEDICARE: RIVERWOODS SURGERY 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	2005ASF70230	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20057023000001	OTHER	UT	BCBS
2	920829	OTHER	UT	DMBA
3	103015041101	OTHER	UT	IHC
4	268010	OTHER	UT	ALTIUS
5	34980	OTHER	UT	HEALTHY U

General Provider Information

NPI Number	:	1538100649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERWOODS SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	320 RIVER PARK DR STE 125
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-6065
Country	:	US
Telephone Number	:	801-437-4500
Fax Number	:	801-437-1400

Provider Business Practice Location Address
First Line	:	320 RIVER PARK DR STE 125
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-6065
Country	:	US
Telephone Number	:	801-437-4500
Fax Number	:	801-437-1400

Authorized Official
Title or Position	:	ACCOUNT MANAGER
Name	:	KIMBERLI CRISP
Credential	:
Telephone Number	:	801-437-4500

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	07/27/2023

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