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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