CENTRAL UTAH CLINIC, P.C. (NPI# 1174642102) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174642102 |
| Entity Type | Organization |
| Organization Name | CENTRAL UTAH CLINIC, P.C. |
| Other Organization Name | REVERE HEALTH |
| Practice Address |
1490 E Foremaster Dr Bldg C St George UT 84790-4550 |
| Mailing Address |
1055 N 500 W Attn: Credentialing Provo UT 84604-3305 |
| Practice Telephone | 4359862238 |
| Practice Fax Number | 4359862237 |
| Mailing Telephone | 8013548225 |
| Mailing Fax Number | 8014180941 |
| Enumeration Date | 2007-03-29 |
| 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 | 261QR0200X |
Clinic/Center Specialization: Radiology |
UT | 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 |
1490 E FOREMASTER DR BLDG C |
| City | ST GEORGE |
| State | UT |
| Zip Code | 84790-4550 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801182357 | Phillip Fairbourn | Radiology | 1490 E Foremaster Dr Bldg C, St George, UT 84790-4550 | 2011-06-23 |
| 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 | 261QR0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Radiology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376144758 | Us Sports Medicine, LLC | Clinic/Center | 729 King St Ste 100, Layton, UT 84041-4681 | 2020-11-03 |
| 1720588080 | Us Sports Medicine, LLC | Clinic/Center | 1982 W. Pleasant Grove Blvd, Suite L, Pleasant Grove, UT 84062 | 2018-02-13 |
| 1477086973 | Us Sports Medicine, LLC | Clinic/Center | 6030 Fashion Point Dr, South Ogden, UT 84403-4851 | 2017-04-11 |
| 1386026052 | Western Neurological Group | Clinic/Center | 10169 S 1160 W, South Jordan, UT 84095-8829 | 2015-06-18 |
| 1558314146 | Ihc Health Services, Inc | Clinic/Center | 674 S Highway 99, Fillmore, UT 84631-5013 | 2006-05-18 |
| 1891248936 | Sacred Circle Healthcare | Clinic/Center | 660 S 200 E, Ste 250, Salt Lake City, UT 84111-3835 | 2016-07-25 |
| 1699004499 | Tooele Valley Imaging, LLC | Clinic/Center | 2356 N 400 E, Suite 103, Tooele, UT 84074-3409 | 2009-12-08 |
| 1306076625 | Fort Duchesne Indian Health Center Radiology | Clinic/Center | 6822 East 1000 South, Fort Duchesne, UT 84026 | 2009-07-21 |
| 1679758296 | Avocet Medical Imaging Inc | Clinic/Center | 1930 S Highway 89, Perry, UT 84302-4119 | 2008-01-02 |
| 1588732309 | Cedar Orthopaedic Bone Densitometry | Clinic/Center | 1335 Northfield Rd, Suite 100, Cedar City, UT 84720-9390 | 2006-12-01 |
| 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.