CENTRAL UTAH CLINIC, P.C. (NPI# 1316330749) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316330749 |
| Entity Type | Organization |
| Organization Name | CENTRAL UTAH CLINIC, P.C. |
| Other Organization Name | REVERE HEALTH |
| Practice Address |
1055 N 500 W Ste 202 Provo UT 84604-3305 |
| Mailing Address |
1055 N 500 W Attn: Credentialing Provo UT 84604-3305 |
| Practice Telephone | 8013742367 |
| Practice Fax Number | 8014298015 |
| Mailing Telephone | 8013548225 |
| Mailing Fax Number | 8014180941 |
| Enumeration Date | 2015-03-10 |
| Last Update Date | 2018-06-16 |
| Authorized Official Name | JED HARSTON (DIRECTOR OF MANAGED CARE) |
| Authorized Official Telephone | 8018125012 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | 9847128-1725 | UT | Suppliers |
| Other Name | Type Code |
|---|---|
| Oncology Dispensing Medical Practice | Other Name - Individual/Organization |
| Oncology Pharmacy | Other Name - Individual/Organization |
| 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 |
| 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 |
| 1437341427 | Central Utah Clinic, P.C. | Radiologic Technologist | 1055 N 500 W, Suite 102, Provo, UT 84604-3305 | 2007-08-14 |
| Street Address |
1055 N 500 W STE 202 |
| City | PROVO |
| State | UT |
| Zip Code | 84604-3305 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699877316 | Steven F Larsen | Nurse Practitioner | 1055 N 500 W Ste 202, Provo, UT 84604-3305 | 2006-09-02 |
| 1063975613 | Vanessa May Dexter | Registered Nurse | 1055 N 500 W Ste 202, Provo, UT 84604-3305 | 2019-04-10 |
| 1790259968 | Michelle Ann Warren | Registered Nurse | 1055 N 500 W Ste 202, Provo, UT 84604-3305 | 2019-01-21 |
| 1376052910 | Whitney Carpenter | Nurse Practitioner | 1055 N 500 W Ste 202, Provo, UT 84604-3305 | 2017-09-27 |
| 1184099764 | Angela Chamberlain | Nurse Practitioner | 1055 N 500 W Ste 202, Provo, UT 84604-3305 | 2015-12-07 |
| 1144497322 | Marc Travis Nuttall | Internal Medicine | 1055 N 500 W Ste 202, Provo, UT 84604-3305 | 2008-05-15 |
| 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 | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093330698 | Granger Medical Clinic, PC | Non-Pharmacy Dispensing Site | 5323 S Woodrow St Ste 203, Murray, UT 84107-5851 | 2020-06-10 |
| 1295070217 | Visible Billing LLC | Non-Pharmacy Dispensing Site | 855 S Diestel Rd, Salt Lake City, UT 84105-1627 | 2012-12-03 |
| 1699051599 | Haaga Mattress | Non-Pharmacy Dispensing Site | 307 E 2100 S, Salt Lake City, UT 84115-2235 | 2011-10-24 |
| 1174753305 | Health & Nutrition, LLC | Non-Pharmacy Dispensing Site | 630 Shepard Ln Ste 102, Farmington, UT 84025-3934 | 2009-07-22 |
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| 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.