# CENTRAL UTAH CLINIC, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Revere Health
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134346976
- **Authorized official:** JED BRADLEY HARSTON (DIRECTOR OF MANAGED CARE)
- **Authorized official phone:** (801) 812-5012

## Contact information

- **Practice address:** 1184 E 80 N, AMERICAN FORK, UT 84003-2906
- **Practice address phone:** (801) 763-3885
- **Practice address fax:** (801) 763-3887
- **Mailing address:** 1055 N 500 W, ATTN: CREDENTIALING, PROVO, UT 84604-3305
- **Mailing address phone:** (801) 354-8225
- **Mailing address fax:** (801) 418-0941

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 2086S0122X | Plastic and Reconstructive Surgery Physician | — | NULL | — |
| 2086S0122X | Plastic and Reconstructive Surgery Physician | — | — | — |

## Other

- **Enumeration date:** 04/20/2007
- **Last updated:** 03/07/2018