Healthcare Provider Details

I. General information

NPI: 1881178580
Provider Name (Legal Business Name): BENJAMIN JOHN RICH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 03/20/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451 S 5600 W SUITE F
WVC UT
84020
US

IV. Provider business mailing address

10433 S REDWOOD RD STE 2
SOUTH JORDAN UT
84095-8502
US

V. Phone/Fax

Practice location:
  • Phone: 801-957-0900
  • Fax: 801-966-4984
Mailing address:
  • Phone: 801-260-1919
  • Fax: 801-260-1441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number7510295-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number7510295-1206
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7510295-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: