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
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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