CENTRAL UTAH CLINIC, P.C. (NPI# 1851631139) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851631139 |
| Entity Type | Organization |
| Organization Name | CENTRAL UTAH CLINIC, P.C. |
| Other Organization Name | REVERE HEALTH |
| Practice Address |
2019 E Riverside Dr Suite A200 St George UT 84790-8134 |
| Mailing Address |
1055 N 500 W Attn: Credentialing Provo UT 84604-3305 |
| Practice Telephone | 4356289298 |
| Practice Fax Number | 4356289655 |
| Mailing Telephone | 8013548225 |
| Mailing Fax Number | 8014180941 |
| Enumeration Date | 2013-02-22 |
| Last Update Date | 2018-03-07 |
| 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 | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
Allopathic & Osteopathic Physicians |
| 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 |
| 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 |
| 1437341427 | Central Utah Clinic, P.C. | Radiologic Technologist | 1055 N 500 W, Suite 102, Provo, UT 84604-3305 | 2007-08-14 |
| Street Address |
2019 E RIVERSIDE DR SUITE A200 |
| City | ST GEORGE |
| State | UT |
| Zip Code | 84790-8134 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114390846 | Pulmonary & Sleep Clinic | Internal Medicine | 2019 E Riverside Dr, St George, UT 84790-8134 | 2015-11-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396342713 | Katrina Poulsen | Student in an Organized Health Care Education/Training Program | 617 East Rriverside Dr, Ste 301, St. George, UT 84790 | 2020-10-08 |
| 1124643226 | Desert View Eyecare | Optometrist | 15 South River Road St. 150, St. George, UT 84790 | 2020-06-15 |
| 1366066417 | Benjamin Todd Lloyd | Dentist | 1683 E. Wolf Hole Dr, St. George, UT 84790 | 2020-06-04 |
| 1801434584 | Jennifer M Putnam | Marriage & Family Therapist | 321 North Mall Drive, Vw103, St. George, UT 84790 | 2019-12-12 |
| 1326683012 | Red Mountain Counseling and Education | Counselor | 321 No Mall Dr, Vw 103, St. George, UT 84790 | 2019-11-17 |
| 1295376002 | Karynne Kimberly Simpson | Behavior Technician | 280 N 1680 E U1, St. George, UT 84790 | 2019-10-02 |
| 1962053017 | Mikala Larsen | Nurse Practitioner | 1380 S Medical Center Dr., Saint George, UT 84790 | 2019-09-20 |
| 1326690678 | Joe Ballent | Student in an Organized Health Care Education/Training Program | 1526 S Medical Center Dr Ste 224a, St George, UT 84790 | 2019-07-16 |
| 1558923854 | David Pace | Optometrist | 749 South River Rd, St. George, UT 84790 | 2019-07-08 |
| 1639734924 | Mariah Ann Mertlich | Behavioral Analyst | 280 N 1680 E, U1, St. George, UT 84790 | 2019-05-02 |
| Find all providers in zip 84790 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871735340 | Zachary Lawrence Reese | Internal Medicine | 544 S 400 E, St George, UT 84770-3705 | 2009-03-30 |
| 1447420401 | Ihc Health Services Inc | Internal Medicine | 544 S 400 E, St George, UT 84770-3705 | 2008-03-06 |
| 1437361185 | Karen Lin | Internal Medicine | 544 S 400 E, St George, UT 84770-3705 | 2007-05-04 |
| 1700946423 | Joseph Derit Te | Internal Medicine | 2019 E Riverside Dr Ste A200, St George, UT 84790-8693 | 2006-12-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881123172 | Scott Marriner Browning | Internal Medicine | 2318 E Field Rose Dr, Salt Lake City, UT 84121-1500 | 2017-06-08 |
| 1356745137 | University of Utah Adult Services | Internal Medicine | 1950 E Circle of Hope Drive, Salt Lake City, UT 84112 | 2014-10-22 |
| 1982049227 | Bryan D Huber | Internal Medicine | 8th Avenue & C Street E8, Salt Lake City, UT 84143-3403 | 2013-04-30 |
| 1285929430 | Brandt L Esplin | Internal Medicine | 1055 N 500 W Ste 202, Bldg C, Provo, UT 84604-8460 | 2011-06-16 |
| 1457664005 | Sabarinath Venniyil Radhakrishna | Internal Medicine | 2000 Circle of Hope, Suite 2100, Huntsman Cancer Institute, Salt Lake City, UT 84112 | 2010-07-23 |
| 1427273705 | Utah Hematology Oncology PC | Internal Medicine | 4403 Harrison Blvd Ste 1685, Ogden, UT 84403-3274 | 2007-04-13 |
| 1225164114 | Finn Bo Petersen | Internal Medicine | E8 Lds Hospital, 8th Avenue and C Street, Salt Lake City, UT 84143-0001 | 2007-02-26 |
| 1124172697 | Justin A Call | Internal Medicine | 3592 W 9000 S, Ste 200, West Jordan, UT 84088-8812 | 2007-01-22 |
| 1164524864 | Jay C Bott | Internal Medicine | 177 S 240 W, Orem, UT 84058-3052 | 2006-09-02 |
| 1417995911 | Wendy A Breyer | Internal Medicine | 5171 S Cottonwood St Ste 610, Murray, UT 84107-5704 | 2006-06-04 |
| Find all providers with the same taxonomy | ||||
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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.