Organization · Type 2 NPI

Central Utah Clinic, P.c.

Non-Pharmacy Dispensing Site · Provo, UT

NPI number 1316330749 Active

Practice location

1055 N 500 W Ste 202
Provo, UT 84604-3305

Call (801) 374-2367 Map

Fax (801) 429-8015

Mailing address

1055 N 500 W, Attn: Credentialing
Provo, UT 84604-3305

Specialties and licenses

Taxonomy	Code	License
Non-Pharmacy Dispensing Site Primary	332900000X	9847128-1725 (UT)

Non-Pharmacy Dispensing Site: A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

5 other providers at this address

NPI record

NPI: 1316330749
Entity type: Organization (Type 2)
Issued: Mar 10, 2015
Last updated: Jun 16, 2018
Status: Active

Other names

<unavail>
Revere Health · doing business as
Revere Health · doing business as
Oncology Dispensing Medical Practice · other name
Oncology Pharmacy · other name

Authorized official

Jed Harston
Director of Managed Care
(801) 812-5012

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1316330749

Central Utah Clinic, P.c.'s National Provider Identifier is 1316330749, issued on Mar 10, 2015. The primary taxonomy on file is Non-Pharmacy Dispensing Site (332900000X), and the practice location is in Provo, UT. The record was last updated on Jun 16, 2018.