RIVERSIDE MEDICAL CENTER LLC NPI 1649567504

NPI Information

RIVERSIDE MEDICAL CENTER LLC is a multi-specialty clinic center in Provo, UT. RIVERSIDE MEDICAL CENTER LLC NPI is 1649567504. The provider is registered as an organization entity type.
The provider Is Doing Business As Blue Rock Medical Center.

The provider's business location address is:

3152 N UNIVERSITY AVE STE 100
PROVO, UT
ZIP 84604-729
Phone: (801) 229-2002
Fax: (801) 229-1003

The provider's authorized official is Barbara Givens .
The authorized official title is Office Manager and has the following contact phone number (801) 229-2002.

The CLIA number assigned to this NPI record is 46D2261257 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/29/2011 and was last updated on 11/1/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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