MEDICARE: RIVERWOODS ANESTHESIA PLLC

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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1821290883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERWOODS ANESTHESIA PLLC

Provider Business Mailing Address
First Line	:	320 RIVER PARK DR STE 195
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-6065
Country	:	US
Telephone Number	:	801-437-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 RIVER PARK DR STE 195
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-6065
Country	:	US
Telephone Number	:	801-437-4500
Fax Number	:	801-374-9195

Authorized Official
Title or Position	:	MEMBER
Name	:	CLARK S ASHBY
Credential	:	MD
Telephone Number	:	801-437-4500

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	04/18/2023

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