CENTRAL UTAH CLINIC, P.C. (NPI# 1689003550) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689003550 |
| Entity Type | Organization |
| Organization Name | CENTRAL UTAH CLINIC, P.C. |
| Other Organization Name | REVERE HEALTH |
| Practice Address |
555 W Sr 164 Salem UT 84653 |
| Mailing Address |
1055 N 500 W Attn: Credentialing Provo UT 84604-3305 |
| Practice Telephone | 8014298000 |
| Mailing Telephone | 8013548225 |
| Mailing Fax Number | 8014180941 |
| Enumeration Date | 2013-11-01 |
| Last Update Date | 2018-03-08 |
| 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 | 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 |
| 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 |
555 W SR 164 |
| City | SALEM |
| State | UT |
| Zip Code | 84653 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104875574 | Tala'at Al-shuqairat | Internal Medicine | 555 W Sr 164, Salem, UT 84653-1666 | 2006-05-10 |
| 1598235798 | Jonathan Rudy Brown | Physician Assistant | 555 W Sr 164, Salem, UT 84653 | 2018-11-29 |
| 1417430497 | Whitney Mccoy | Physician Assistant | 555 W Sr 164, Salem, UT 84653 | 2018-09-14 |
| 1467955526 | Tye Frank Johnson | Physician Assistant | 555 W Sr 164, Salem, UT 84653 | 2018-03-15 |
| 1861912693 | Sarah Larsen | Physical Therapist | 555 W Sr 164, Salem, UT 84653 | 2017-06-22 |
| 1265882070 | Jonathan D Nelson | Physician Assistant | 555 W Sr 164, Salem, UT 84653 | 2016-06-13 |
| 1528426988 | Alex S Moore | Physical Therapist | 555 W Sr 164, Salem, UT 84653 | 2016-02-01 |
| 1205224276 | Shawn Stephen Hill | Physician Assistant | 555 W Sr 164, Salem, UT 84653-1635 | 2014-12-29 |
| 1528461019 | Lindsey Kenz Seaver | Physician Assistant | 555 W Sr 164, Salem, UT 84653-1635 | 2014-09-29 |
| 1073930020 | Seth James Coynor | Pediatrics | 555 W Sr 164, Salem, UT 84653 | 2014-03-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487008603 | Douglas Robert Clark | Optometrist | 446 N State Road 198, Salem, UT 84653 | 2016-04-14 |
| 1811357791 | Melanie Pace | Dental Hygienist | 818 East 750 South, Salem, UT 84653 | 2016-03-04 |
| 1265773899 | Bill Clifford Marshall | Marriage & Family Therapist | 405 S Maple Dr, Woodland Hills, UT 84653 | 2013-03-06 |
| 1013159995 | Elder Assisted Living LLC | Assisted Living Facility | 1015 S 550 W, Salem, UT 84653 | 2009-03-24 |
| 1780884247 | David Kent Hansen | Dentist | 204 East 400 North, Suite A, Salem, UT 84653 | 2007-07-23 |
| 1154524965 | Justin Thomas Perry | Dentist | 40 South 200 West, Salem, UT 84653 | 2007-06-08 |
| 1013130947 | John E Braithwaite | Dentist | 40 S 200 W, Salem, UT 84653 | 2007-04-10 |
| 1104972827 | Salem City Corporation | Ambulance | 30 W 100 S, Salem, UT 84653 | 2007-01-26 |
| 1700989209 | James Bryan Bonny | Dentist | 245 W State Hwy 198, Suite 6, Salem, UT 84653 | 2006-09-07 |
| 1578574570 | Kids Who Count | Day Training, Developmentally Disabled Services | 345 N Sr 198, Salem, UT 84653 | 2006-08-11 |
| Find all providers in zip 84653 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
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| 1871632000 | Cascadia Behavioral Healthcare Inc | Clinic/Center | 1137 25th St Ne, Salem, OR 97301-1604 | 2007-02-05 |
| 1538238928 | Cascadia Behavioral Healthcare Inc | Clinic/Center | 1095 25th St Se, Salem, OR 97301-5049 | 2006-11-07 |
| 1114967817 | Cascadia Behavioral Healthcare Inc | Clinic/Center | 3321 Harold Dr Ne, Salem, OR 97305-1339 | 2006-06-08 |
| 1679520787 | Cascadia Behavioral Healthcare Inc | Clinic/Center | 3325 Harold Dr Ne, Salem, OR 97305-1339 | 2006-05-27 |
| 1104322841 | Lilac Wellness | Clinic/Center | 2651 Commercial St Se Ste 1, Salem, OR 97302-4872 | 2018-04-02 |
| 1215448907 | Edge Medical Services Inc. | Clinic/Center | 13160 Jerusalem Hill Rd Nw, Salem, OR 97304-9622 | 2017-10-20 |
| 1235674136 | Breathe Easy With Jenn, PC | Clinic/Center | 3000 Market St Ne Ste 541, Salem, OR 97301-1835 | 2016-12-30 |
| 1902104094 | Alouf Aesthetics | Clinic/Center | 1602 Apperson Dr, Salem, VA 24153-7217 | 2011-03-14 |
| 1942233986 | Central Utah Clinic, P.C. | Clinic/Center | 555 W Sr 164, Salem, UT 84653 | 2006-07-09 |
| Find all providers in SALEM | ||||
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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.