Central Utah Clinic, P.C.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CENTRAL UTAH CLINIC, P.C.

Doing business as

Revere Health

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

Last updated

Mar 7, 2018By the provider in NPPES

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

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

CLIA laboratory certificates

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

{
    "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revere Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Center for Couples & Families (A Southern Utah Counseling Experience)
• Center for Stress Reduction, Inc.
• Centerfield Healthcare (Summit Hospice St. George)
• Centerfield Healthcare (Summit Home Health St. George)
• Central Utah Clinic, P.C. (Revere Health)
• Central Utah Clinic, P.C. (Revere Health)
• Lisa Certonio, NNP-BC
• Matthew Certonio, NP
• Alessandra Cervantes
• Rita Rose Cervantes

• Family Medicine Physician in St George, UT
• Providers in St George, UT by specialty
• Family Medicine Physician 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.