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REVERE HEALTH
NPI 1689003550
Clinic/Center - Multi-Specialty in Salem, UT

Active since November 01, 2013CLIA Certified · 4 labs

NPPES record last updated: March 8, 2018. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Mar 8, 2018, Apr 18, 2017 (2 updates tracked since 2017).

About Revere Health NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

REVERE HEALTH (NPI 1689003550) is a healthcare organization registered as a multi-specialty in Salem, Utah and active in the NPI registry since November 2013. The organization holds 4 active CLIA laboratory certificates and lists Jed Harston, Director Of Managed Care, as its authorized official.

NPPES Registry Identity

NPI1689003550
Entity TypeOrganization
Primary Taxonomy261QM1300X
Legal Business NameCENTRAL UTAH CLINIC, P.C.
Location Address555 W SR 164Salem, UT 84653
Mailing Address1055 N 500 W, Attn: CredentialingProvo, UT 84604-3305 · (801) 354-8225 · Fax (801) 418-0941
Phone(801) 429-8000
Organization SubpartNo
Authorized OfficialJed HarstonDirector Of Managed Care · (801) 812-5012
Enumeration DateNovember 1, 2013
Last NPPES UpdateMarch 8, 20182 updates tracked since enumeration
✔ NPI 1689003550 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Multi-SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM1300X
555 W SR 164, Salem, UT 84653
Open in Google Maps ↗

Other Names 1

Doing Business AsRevere Health

CLIA Laboratory Certificates CMS CLIA 4

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 46D2138257

Revere Health Salem Dermatology · Salem, UT
Active · expires Mar 28, 2028
CLIA Number46D2138257
Laboratory TypePhysician Office
Certificate Effective DateMarch 29, 2026
Certificate Expiration DateMarch 28, 2028
Laboratory DirectorReed Garza
Laboratory Phone(801) 374-8999
Laboratory LocationRevere Health Salem Dermatology555 West Sr-164, Salem, UT 84653
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Accreditation 46D0525629

Revere Health Scip Lab · Salem, UT
Active · expires Oct 16, 2027
CLIA Number46D0525629
Laboratory TypePhysician Office
Certificate Effective DateOctober 17, 2025
Certificate Expiration DateOctober 16, 2027
Laboratory DirectorMr. Bryan L. Evensen
Laboratory Phone(385) 203-1222
Laboratory LocationRevere Health Scip Lab555 W Sr 164 Suite 105, Salem, UT 84653
CLIA data matches this NPI record on: Address Name
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Certificate of Compliance 46D2241864

Revere Health Salem Urgent Care · Salem, UT
Active · expires Apr 24, 2028
CLIA Number46D2241864
Laboratory TypePhysician Office
Certificate Effective DateApril 25, 2026
Certificate Expiration DateApril 24, 2028
Laboratory DirectorAshley N. Pardo
Laboratory Phone(385) 265-6050
Laboratory LocationRevere Health Salem Urgent Care555 W State Road 164 Suite 105, Salem, UT 84653
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Waiver 46D0909414

Revere Health Scip Im · Salem, UT
Active · expires Dec 28, 2026
CLIA Number46D0909414
Laboratory TypePhysician Office
Certificate Effective DateDecember 29, 2024
Certificate Expiration DateDecember 28, 2026
Laboratory DirectorBrian P. Tudor
Laboratory Phone(435) 465-4813
Laboratory LocationRevere Health Scip Im2nd Floor, 1st Hall 555 W 2000 North, Salem, UT 84653
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ROBERT WRIGHT PA-C
Physician Assistant
555 W SR 164
SALEM, UT 84653
Utah County (801) 465-4896
TALA'AT AL-SHUQAIRAT MD
Internal Medicine (Pulmonary Disease)
555 W SR 164
SALEM, UT 84653
Utah County (801) 465-4813
DR. TROY LUNCEFORD MD
Internal Medicine
555 W SR 164
SALEM, UT 84653
Utah County (801) 465-4813
SHAWN STEPHEN HILL MPAS
Physician Assistant
555 W SR 164
SALEM, UT 84653
Utah County (801) 465-4813
NATHAN SANBORN PA
Physician Assistant
555 W SR 164
SALEM, UT 84653
Utah County (801) 465-4896
DR. TRAVIS BRANDON CHARLES D.O.
Family Medicine
555 W SR 164
SALEM, UT 84653
Utah County (385) 265-6050
BRIAN A CLEMENTS DO
Internal Medicine
555 W SR 164
SALEM, UT 84653
Utah County (801) 465-4813
JONATHAN D NELSON PA-C
Physician Assistant
555 W SR 164
SALEM, UT 84653
Utah County (801) 465-4813

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Central Utah Clinic, P.C.'s NPI number?

The NPI number for Central Utah Clinic, P.C. is 1689003550. It was assigned to this organization in the NPPES registry on November 1, 2013. The provider is doing business as Revere Health.

Where is Central Utah Clinic, P.C. located?

Central Utah Clinic, P.C. is located at 555 W Sr 164, Salem, UT 84653. The listed phone number is (801) 429-8000.

What is Central Utah Clinic, P.C.'s specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.

Does Central Utah Clinic, P.C. hold CLIA laboratory certificates?

Yes. 4 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Central Utah Clinic, P.C. was last updated on March 8, 2018. NPI Profile syncs with the weekly NPPES data releases published by CMS.