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
736 S 900 E STE 203, ST GEORGE, UT 84790-7003
(435) 673-6131
(435) 673-8557
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
207Q00000X
Family Medicine Physician
Primary
—
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
46D0525920
CLIA NUMBER
UT
Enumeration date
10/03/2006
Last updated
03/07/2018
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