NPIMap

Organization Active NPI

Tko Aesthesia

  • Clinic/Center
  • Saint George, UT
National Provider Identifier
1386223683
Registry record updated Apr 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
TKO AESTHESIA
Practice address
754 S Main St Ste 3&4
Saint George, UT 84770-5504
Phone
(435) 628-2671
NPI assigned
Apr 5, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jack Bradley Waters, APRN-CRNANPI 1407152358
Title
Manager
Phone
(435) 773-5585

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

754 S Main St Ste 3&4
Saint George, UT 84770-5504

Mailing address

1401 N 2200 W
Saint George, UT 84770-5756
Phone (435) 773-5585

National Provider Directory

National Provider Directory

Locations

754 S Main St
Ste 34
Saint George, UT 84770
Phone (435) 628-2671

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617580800000",
    "number": "1386223683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 N 2200 W",
            "city": "SAINT GEORGE",
            "state": "UT",
            "postal_code": "847705756",
            "telephone_number": "435-773-5585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "754 S MAIN ST STE 3&4",
            "city": "SAINT GEORGE",
            "state": "UT",
            "postal_code": "847705504",
            "telephone_number": "435-628-2671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TKO AESTHESIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-05",
        "last_updated": "2021-04-05",
        "certification_date": "2021-04-05",
        "status": "A",
        "authorized_official_last_name": "WATERS",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "BRADLEY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "435-773-5585",
        "authorized_official_credential": "APRN-CRNA"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint George, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.