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
2019 E RIVERSIDE DR, SUITE A200, ST GEORGE, UT 84790-8134
(435) 628-9298
(435) 628-9655
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
207RH0003X
Hematology & Oncology Physician
Primary
—
—
Other
Enumeration date
02/22/2013
Last updated
03/07/2018
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