CENTRAL UTAH CLINIC, P.C. (NPI# 1093764805) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093764805 |
| Entity Type | Organization |
| Organization Name | CENTRAL UTAH CLINIC, P.C. |
| Other Organization Name | REVERE HEALTH |
| Practice Address |
1055 N 500 W Provo UT 84604-3305 |
| Mailing Address |
1055 N 500 W Credentialing Department Provo UT 84604-3305 |
| Practice Telephone | 8014298000 |
| Practice Fax Number | 8014298150 |
| Mailing Telephone | 8013548225 |
| Mailing Fax Number | 8014180941 |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2018-03-07 |
| Authorized Official Name | SCOTT D BARLOW (CHIEF EXECUITIVE OFFICER) |
| Authorized Official Telephone | 8014298034 |
| Authorized Official Credential | CEO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Revere Health | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669930475 | Central Utah Clinic, P.C. | Clinic/Center | 330 Falcon Ridge Pkwy Ste 400a, Mesquite, NV 89027-8881 | 2019-03-11 |
| 1851631139 | Central Utah Clinic, P.C. | Internal Medicine | 2019 E Riverside Dr, Suite A200, St George, UT 84790-8134 | 2013-02-22 |
| 1508896838 | Central Utah Clinic, P.C. | Family Medicine | 97 S Professional Way, Suite 2, Payson, UT 84651-1614 | 2006-07-03 |
| 1265907620 | Central Utah Clinic, P.C. | Eyewear Supplier (Equipment, not the service) | 5872 S 900 E Ste 100, Murray, UT 84121-1677 | 2018-10-11 |
| 1316330749 | Central Utah Clinic, P.C. | Non-Pharmacy Dispensing Site | 1055 N 500 W Ste 202, Provo, UT 84604-3305 | 2015-03-10 |
| 1689003550 | Central Utah Clinic, P.C. | Clinic/Center | 555 W Sr 164, Salem, UT 84653 | 2013-11-01 |
| 1780017954 | Central Utah Clinic, P.C. | Orthopaedic Surgery | 700 W 800 N Ste 100, Orem, UT 84057-6302 | 2013-08-12 |
| 1760752943 | Central Utah Clinic, P.C. | Orthopaedic Surgery | 1490 E Foremaster Dr, Suite 150, St George, UT 84790-4488 | 2012-01-05 |
| 1841433927 | Central Utah Clinic, P.C. | Urology | 15 S 1000 E, Suite 225, Payson, UT 84651-5590 | 2009-04-20 |
| 1023251204 | Central Utah Clinic, P.C. | Clinic/Center | 3000 N Triumph Blvd Ste 100, Lehi, UT 84043-4999 | 2009-04-17 |
| Street Address |
1055 N 500 W |
| City | PROVO |
| State | UT |
| Zip Code | 84604-3305 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144223835 | Bruce C Mcallister | Specialist | 1055 N 500 W, Suite 102, Provo, UT 84604-3305 | 2005-05-27 |
| 1922641448 | Lilian Silva Dana | Nurse Practitioner | 1055 N 500 W, Suite. 222, Bldg. C, Provo, UT 84604 | 2019-10-28 |
| 1407373574 | Kristie Christensen | Nurse Practitioner | 1055 N 500 W, Ste 101, Bldg C, Provo, UT 84604-3305 | 2017-08-29 |
| 1942664867 | Holly Ann Bishop Michaels | Dietitian, Registered | 1055 N 500 W, Attn. Credentialing, Provo, UT 84604-3305 | 2016-04-06 |
| 1841650967 | Maile Yuzon | Physician Assistant | 1055 N 500 W, Ste 212, Provo, UT 84604-3305 | 2016-03-02 |
| 1497127658 | Kayla Hamrick Lussier | Nurse Practitioner | 1055 N 500 W, Suite 212, Provo, UT 84604-3305 | 2015-10-28 |
| 1962873281 | Ryan Francis | Nurse Practitioner | 1055 N 500 W, Ste 121, Provo, UT 84604-3305 | 2015-10-13 |
| 1083082283 | Leslee Ronald Adams | Registered Nurse | 1055 N 500 W, Ste 211, Provo, UT 84604-3305 | 2015-09-04 |
| 1750763629 | Cydne Suzannah Baird Evans | Physician Assistant | 1055 N 500 W, Ste 100, Provo, UT 84604-3305 | 2015-06-26 |
| 1073903720 | Rosanne Johnson Oliver | Nurse Practitioner | 1055 N 500 W, Ste 205, Provo, UT 84604-3305 | 2015-02-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346882107 | Abigail Belle Hardy | Student in an Organized Health Care Education/Training Program | 1190 900 E, Provo, UT 84604 | 2019-10-14 |
| 1386106698 | Sarah Roseman Hunt | Nurse Practitioner | 1055 N 500 W., Suite. 101, Bldg. C, Provo, UT 84604 | 2019-04-04 |
| 1255813325 | Hwigeum Jeong | Specialist/Technologist | Department of Exercise Sciences 106 Sfh Brigham Young, Provo, UT 84604 | 2018-09-05 |
| 1093203044 | Snowcap Smile Studio LLC | Dentist | 2230 N. University Pkwy Ste 8b, Provo, UT 84604 | 2018-04-25 |
| 1407359078 | Ihc Health Services Inc | Clinic/Center | 380 W Bulldog Blvd, Ste 403, Provo, UT 84604 | 2018-03-09 |
| 1902308455 | Afton Leuga | Nurse Practitioner | 395 W Bulldog Blvd., Suite 401, Provo, UT 84604 | 2018-03-01 |
| 1851807333 | Ihc Health Services Inc | Family Medicine | 380 W 1230 N, Ste 602, Provo, UT 84604 | 2017-12-20 |
| 1689180218 | Ihc Health Services Inc | Pediatrics | 395 W Bulldog Blvd Ste 703, Provo, UT 84604 | 2017-12-19 |
| 1396254165 | Nicolas Sorensen | Massage Therapist | 247 West 2230 North #201, Provo, UT 84604 | 2017-09-25 |
| 1437692241 | Cirque Lodge Inc | Substance Abuse Rehabilitation Facility | 3114 E Ida's Road, Sundance, UT 84604 | 2016-11-28 |
| Find all providers in zip 84604 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063028991 | Atlas Epigenetics | Clinic/Center | 3311 N University Ave Ste 150, Provo, UT 84604-7431 | 2020-09-16 |
| 1649567504 | Riverside Medical Center LLC | Clinic/Center | 3152 N University Ave Ste 100, Provo, UT 84604-4729 | 2011-06-29 |
| 1992942635 | Ihc Health Services Inc | Clinic/Center | 750 W 200 N, Provo, UT 84601-2606 | 2009-01-16 |
| 1194330118 | Neural Effects | Clinic/Center | 1055 N 300 W Ste 410, Provo, UT 84604-3354 | 2020-09-15 |
| 1477678589 | Ihc Health Services Inc | Clinic/Center | 1034 N 500 W, Provo, UT 84604-3380 | 2007-03-20 |
| 1326096728 | Intermountain Healthcare | Clinic/Center | 1055 N 300 W, 500, Provo, UT 84604-3344 | 2006-05-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649882069 | Vasco Healthcare Inc | Clinic/Center | 470 E 3900 S Ste 100, Salt Lake City, UT 84107-2331 | 2020-08-18 |
| 1467082644 | Treatment Network LLC | Clinic/Center | 12608 S 125 W Ste B2, Draper, UT 84020-5443 | 2020-01-16 |
| 1750928214 | Kyunghee Seo K Mental Health Clinic | Clinic/Center | 1160 S State St Ste 160a, Orem, UT 84097-8263 | 2019-12-04 |
| 1740836345 | The Lift Clinic, LLC | Clinic/Center | 345 W 100 S # 6c, Slc, UT 84101-1209 | 2019-08-11 |
| 1952953101 | Restorative Health Primary Care | Clinic/Center | 850 E 9400 S Ste 101, Sandy, UT 84094-4114 | 2019-07-09 |
| 1063986800 | Healthworks Med Group of Utah P C | Clinic/Center | 4163 S 3200 W, West Valley City, UT 84119-5128 | 2019-01-15 |
| 1235615790 | Community Birth Group | Clinic/Center | 1190 E 5425 S Ste 330, South Ogden, UT 84403-4548 | 2018-07-17 |
| 1275044075 | Edge Medical Services Inc. | Clinic/Center | 959 W Sedge Ct, Farmington, UT 84025-2541 | 2017-10-19 |
| 1992214027 | National Birth Centers, Inc | Clinic/Center | 4345 S Vallejo Dr, Holladay, UT 84124-3756 | 2017-09-20 |
| 1184149361 | Positive Pathways | Clinic/Center | 23 S Carbon Ave Ste 8, Price, UT 84501-2831 | 2017-08-08 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on CENTRAL UTAH CLINIC, P.C..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.