Organization Name: | RIVERWOOD ADVANCED DIAGNOSTIC IMAGING |
NPI Number: | 1194818278 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WENDELL A GIBBY (OWNER) |
Mailing Address: | 3152 N University Ave Suite 100 Provo |
State: | UT US |
Postal Code: | 846044729 |
Phone Number: | 8014374895 |
Fax Number: | 8012291003 |
NPI Enumeration Date: | 10/02/2006 |
NPI Last Update Date: | 10/27/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 5414031-1704 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |