Central Utah Clinic, P.C.
Organization Active NPI Family Medicine Physician · Payson, UT
NPI 1508896838 · NPPES record last updated Mar 7, 2018
Key facts
- NPI
- 1508896838
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- CENTRAL UTAH CLINIC, P.C.
- Practice address
- 97 S Professional Way
Suite 2
Payson, UT 84651-1614 - Phone
- (801) 465-4896
- Fax
- (801) 465-4107
- NPI assigned
- Jul 3, 2006
- Organization subpart
- No
Authorized official
- Name
- Jed Harston
- Title
- Director of Managed Care
- Phone
- (801) 812-5012
Corporate family (same tax ID) 10
National Provider Directory
- Tax ID family
- Walstir H Fonseca MD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
97 S Professional Way
Suite 2
Payson, UT 84651-1614
Mailing address
1055 N 500 W
Attn: Credentialing
Provo, UT 84604-3305
Phone (801) 354-8225
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 870609595000 | Medicaid | UT |
Other names
- Revere Health
Other providers in Payson, UT
- Cascade Family Dental
- John Frederick Catlett Jr.
- Taylar Karleen Cazier
- Ccrmed Inc
- Ccrmed Inc Corp
- Central Utah Clinic, P.C.
- Central Utah Optical
- Central Utah Pathology LLC
- Stephen Bret Chipman
- James Dean Christensen
All providers in Payson, UT · Family Medicine Physician in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.