Provider Demographics
NPI:1104065200
Name:RIVERTON ONCOLOGY PRACTICE,LLC
Entity type:Organization
Organization Name:RIVERTON ONCOLOGY PRACTICE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BIVACCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-856-4688
Mailing Address - Street 1:PO BOX 758
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83877-0758
Mailing Address - Country:US
Mailing Address - Phone:307-856-4688
Mailing Address - Fax:307-856-1740
Practice Address - Street 1:1035 ROSE LN
Practice Address - Street 2:STE D
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2286
Practice Address - Country:US
Practice Address - Phone:307-856-4688
Practice Address - Fax:307-856-1740
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFEPOINT HOSPITALS HOLDINGS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty