Central Utah Clinic, P.C.

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

Legal business name

CENTRAL UTAH CLINIC, P.C.

Practice address

1490 E Foremaster Dr BLDG C
St George, UT 84790-4550

Phone

(435) 986-2238

Fax

(435) 986-2237

NPI assigned

Mar 29, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jed Harston

Title

Director of Managed Care

Phone

(801) 812-5012

Specialties & licenses 1

Addresses

Other names 1

• Revere Health Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520380800000",
    "number": "1174642102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "address_2": "ATTN: CREDENTIALING",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "801-354-8225",
            "fax_number": "801-418-0941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1490 E FOREMASTER DR BLDG C",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847904550",
            "telephone_number": "435-986-2238",
            "fax_number": "435-986-2237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL UTAH CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2018-03-07",
        "status": "A",
        "authorized_official_last_name": "HARSTON",
        "authorized_official_first_name": "JED",
        "authorized_official_title_or_position": "DIRECTOR OF MANAGED CARE",
        "authorized_official_telephone_number": "801-812-5012"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "UT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revere Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Center for Couples & Families
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• Centerfield Healthcare
• Centerfield Healthcare
• Central Utah Clinic, P.C.
• Central Utah Clinic, P.C.
• Lisa Certonio, NNP-BC
• Matthew Certonio, NP
• Alessandra Cervantes

• Radiology Clinic/Center in St George, UT
• Providers in St George, UT by specialty
• Radiology Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.