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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