Central Utah Clinic, P.C.

Key facts

NPI

1295829281

Entity type

Organization (NPI type 2)

Primary specialty

Family Medicine Physician 207Q00000X

Legal business name

CENTRAL UTAH CLINIC, P.C.

Practice address

736 S 900 E Ste 203
St George, UT 84790-7003

Phone

(435) 673-6131

Fax

(435) 673-8557

NPI assigned

Oct 3, 2006

Organization subpart

No

Authorized official

Name

Jed Harston

Title

Director of Managed Care

Phone

(801) 812-5012

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

National Provider Directory

Specialties & licenses

Addresses

Other identifiers

Other names

• Revere Health Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 7, 2018.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520380800000",
    "number": "1295829281",
    "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": "736 S 900 E STE 203",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847907003",
            "telephone_number": "435-673-6131",
            "fax_number": "435-673-8557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL UTAH CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "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": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "UT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA NUMBER",
            "identifier": "46D0525920",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revere Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St George, UT

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

All providers in St George, UT · Family Medicine Physician in Utah