# CENTRAL UTAH CLINIC, P.C.

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

## Provider details

- **NPI number:** 1851631139
- **Authorized official:** JED HARSTON (DIRECTOR OF MANAGED CARE)
- **Authorized official phone:** (801) 812-5012

## Contact information

- **Practice address:** 2019 E RIVERSIDE DR, SUITE A200, ST GEORGE, UT 84790-8134
- **Practice address phone:** (435) 628-9298
- **Practice address fax:** (435) 628-9655
- **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 |
| --- | --- | --- | --- | --- |
| 207RH0003X | Hematology & Oncology Physician | — | NULL | Yes |
| 207RH0003X | Hematology & Oncology Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/22/2013
- **Last updated:** 03/07/2018