Organization
CENTRAL UTAH CLINIC PC
Active
Organization
CENTRAL UTAH CLINIC PC
Active
Other names
REVERE HEALTH
Organization subpart
No
Provider details
NPI number
Authorized official
JED BRADLEY HARSTON (DIRECTOR OF PAYER RELATIONS)
(801) 812-5012
Entity
Organization
Contact information
Practice address
972 N 600 E, SPANISH FORK, UT 84660-1306
(801) 373-7350
(801) 812-5401
Mailing address
1055 N 500 W, ATT CREDENTIALING, PROVO, UT 84604
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
04/01/2024
Last updated
04/01/2024
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