Central Utah Clinic, P.C.

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

2007ASF78284 Issued in UT

Legal business name

CENTRAL UTAH CLINIC, P.C.

Doing business as

Revere Health

Practice address

1175 E 50 S
Suite 101
American Fork, UT 84003-0000

Phone

(801) 492-5994

Fax

(801) 418-0899

NPI assigned

Jan 26, 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

Locations

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520380800000",
    "number": "1437205028",
    "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": "1175 E 50 S",
            "address_2": "SUITE 101",
            "city": "AMERICAN FORK",
            "state": "UT",
            "postal_code": "840030000",
            "telephone_number": "801-492-5994",
            "fax_number": "801-418-0899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL UTAH CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "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": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "UT",
            "license": "2007ASF78284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revere Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Revere Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lourdes Castro-Ramirez, CSW
• Marilee Castro, MS CCC-SLP
• Judy E Ceccherini, LMFT
• Central Utah Clinic, P.C.
• Central Utah Clinic, P.C.
• Central Utah Foot Clinic, LLC
• Central Utah Optical
• Clarisse Marie Chadwick, LPC
• Sadey Jo Chadwick, FNP
• Laurie Lynne Chamberlain

• Ambulatory Surgical Clinic/Center in American Fork, UT
• Providers in American Fork, UT by specialty
• Ambulatory Surgical 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.