Active NPI
Tristan Scott Benedict
- Other Technician
- St George, UT
National Provider Identifier
1780033795
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- License
- 197272669
- Practice address
- 474 W 200 N
St George, UT 84770-4505 - Phone
- (435) 634-5600
- Fax
- (435) 986-8700
- NPI assigned
- Jun 9, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | 197272669 | UT | Primary |
Addresses
Primary practice location
474 W 200 N
St George, UT 84770-4505
Mailing address
260 S 460 W
Hurricane, UT 84737-2177
Phone (435) 218-4927
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 197272669 | UT | MD | Other Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1465430400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465430400000",
"number": "1780033795",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "260 S 460 W",
"city": "HURRICANE",
"state": "UT",
"postal_code": "847372177",
"telephone_number": "435-218-4927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "474 W 200 N",
"city": "ST GEORGE",
"state": "UT",
"postal_code": "847704505",
"telephone_number": "435-634-5600",
"fax_number": "435-986-8700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENEDICT",
"first_name": "TRISTAN",
"middle_name": "SCOTT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-06-09",
"last_updated": "2016-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "UT",
"license": "197272669",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St George, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.