Central Utah Clinic, P.C.
Clinic/Center, Multi-Specialty in Mesquite, NV. Organization (NPI-2).
NPI number1669930475
StatusActive
Last updated in NPPESMar 11, 2019
Details
- NPI
- 1669930475
- Entity type
- Organization (NPI-2)
- Legal business name
- Central Utah Clinic, P.C.
- Organization subpart
- No
- Enumeration date
- Mar 11, 2019
- Last updated
- Mar 11, 2019
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM1300X | Clinic/Center, Multi-Specialty | – | – | Yes |
Other names
- Revere Health (Doing Business As)
Practice location
330 Falcon Ridge Pkwy Ste 400aMesquite, NV 89027-8881
Phone 801-377-5757 · Fax 801-418-0941
Mailing address
1055 N 500 WAttn: Credentialing
Provo, UT 84604-3305
Phone 801-354-8225 · Fax 801-418-0941
Authorized official
Jed Bradley Harston
Director Of Payer Relations
8018125012
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