NPIMap

Organization Active NPI

Central Utah Clinic, P.C.

Doing business as Revere Health

  • Multi-Specialty Clinic/Center
  • Salem, UT
National Provider Identifier
1689003550
Registry record updated Mar 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
CENTRAL UTAH CLINIC, P.C.
Doing business as
Revere Health
Practice address
555 W Sr 164
Salem, UT 84653
Phone
(801) 429-8000
NPI assigned
Nov 1, 2013
Last updated
Mar 8, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2018

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

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

555 W Sr 164
Salem, UT 84653

Mailing address

1055 N 500 W
Attn: Credentialing
Provo, UT 84604-3305
Phone (801) 354-8225

Other names 1

  • Revere Health Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Central Utah Med Clinic11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

555 W State Road 164
Salem, UT 84653
Phone (801) 465-4896

NPI Registry JSON

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

{
    "created_epoch": "1383264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520467200000",
    "number": "1689003550",
    "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": "555 W SR 164",
            "city": "SALEM",
            "state": "UT",
            "postal_code": "84653",
            "telephone_number": "801-429-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL UTAH CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-01",
        "last_updated": "2018-03-08",
        "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": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revere Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salem, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 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.