CENTRAL UTAH CLINIC, P.C.


Address: 555 W Sr 164, Salem, UT 84653
Phone: 8014298000

CENTRAL UTAH CLINIC, P.C. (NPI# 1942233986) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1942233986
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 2006-07-09
Last Update Date 2020-01-14
Authorized Official Name JED HARSTON (DIRECTOR OF MANAGED CARE)
Authorized Official Telephone 8018125012
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QM1300X Clinic/Center
Specialization: Multi-Specialty
Ambulatory Health Care Facilities

Other Provider/Organization Names

Other Name Type Code
Revere Health Doing Business As Name - Organization

Other Provider IDs and Locations

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

Office Location

Street Address 555 W SR 164
City SALEM
State UT
Zip Code 84653

Providers in the same location

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
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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 261QM1300X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Multi-Specialty

Taxonomy Definition

Definition to come...

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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
1689003550 Central Utah Clinic, P.C. Clinic/Center 555 W Sr 164, Salem, UT 84653 2013-11-01
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Competitor

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City SALEM
Zip Code 84653

Improve Information

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Dataset Information

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.

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