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Organization
CENTRAL UTAH CLINIC, P.C.
Active
Organization
CENTRAL UTAH CLINIC, P.C.
Active
Other names
Revere Health
Organization subpart
No
Provider details
NPI number
Authorized official
JED BRADLEY HARSTON (DIRECTOR OF MANAGED CARE)
(801) 812-5012
Entity
Organization
Contact information
Practice address
1184 E 80 N, AMERICAN FORK, UT 84003-2906
(801) 763-3885
(801) 763-3887
Mailing address
1055 N 500 W, ATTN: CREDENTIALING, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
—
NULL
2086S0122X
Plastic and Reconstructive Surgery Physician
—
—
Other
Enumeration date
04/20/2007
Last updated
03/07/2018
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