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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 HARSTON (DIRECTOR OF MANAGED CARE)
(801) 812-5012
Entity
Organization
Contact information
Practice address
1175 E 50 S, SUITE 101, AMERICAN FORK, UT 84003-0000
(801) 492-5994
(801) 418-0899
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
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
2007ASF78284
UT
Other
Enumeration date
01/26/2007
Last updated
03/07/2018
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