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
1175 E 50 S, AMERICAN FORK, UT 84003-0000
(801) 429-8000
(801) 429-8150
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
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
05/21/2007
Last updated
03/07/2018
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