REVERE HEALTH
NPI 1174642102
Clinic/Center - Radiology in St George, UT
- Organization
- Clinic/Center
- Radiology
- CLIA Number: 46D0525920
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 03-31-2027
About REVERE HEALTH
This page provides the complete NPI Profile along with additional information for Revere Health, a provider established in St George, Utah operating as a Clinic/center, focusing in radiology . The healthcare provider is registered in the NPI registry with number 1174642102 assigned on March 2007. The practitioner's primary taxonomy code is 261QR0200X. The provider is registered as an organization and their NPI record was last updated 8 years ago. The provider's is doing business as Revere Health. The authorized official of this NPI record is Jed Harston (Director Of Managed Care)
- NPI
- 1174642102 Verify this NPI
- Provider Legal Name
- CENTRAL UTAH CLINIC, P.C.
- Other Organization Name
- REVERE HEALTH
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 1490 E FOREMASTER DR BLDG C ST GEORGE, UT 84790
- Location Phone
- (435) 986-2238
- Location Fax
- (435) 986-2237
- Mailing Address
- 1055 N 500 W ATTN: CREDENTIALING PROVO, UT 84604
- Mailing Phone
- (801) 354-8225
- Mailing Fax
- (801) 418-0941
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 03-29-2007
- Last Update Date
- 03-07-2018
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Radiology
- Taxonomy Code
- 261QR0200X
- Type
- Ambulatory Health Care Facilities
- License State
- UT
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 46D0525920
- Facility Type
- Physician Office
- Certificate Effective Date
- April 01, 2025
- Certificate Expiration Date
- March 31, 2027
- Laboratory Director
- ERIC J. SMITH MT ASCP
- Certificate Type
- Certificate for Provider-Performed Microscopy Procedures (PPMP)
- Certificate Type Description
- This CLIA certificate is issued to Revere Health in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.
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Other Providers at the Same Location
The following 2 providers are registered at the same or a nearby location.
SAINT GEORGE, UT 84790
ST GEORGE, UT 84790
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1174642102, enumerated as an "organization" on March 29, 2007.
The provider is located at 1490 E FOREMASTER DR BLDG C ST GEORGE, UT 84790 and the phone number is (435) 986-2238.
Clinic/Center with taxonomy code 261QR0200X and a focus in Radiology.
