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Organization

CENTRAL UTAH CLINIC, P.C.

Active
Other names
Revere Health, Oncology Pharmacy, Oncology Dispensing Medical Practice
Organization subpart
No

Provider details

NPI number
Authorized official
JED HARSTON (DIRECTOR OF MANAGED CARE)
(801) 812-5012
Entity
Organization

Contact information

Practice address
1055 N 500 W STE 202, PROVO, UT 84604-3305
(801) 374-2367
(801) 429-8015
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
332900000X
Non-Pharmacy Dispensing Site
Primary
9847128-1725
UT

Other

Enumeration date
03/10/2015
Last updated
06/16/2018
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