Basic Information
| Provider Information | |||||||||
| NPI: | 1063474518 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENSON | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 1ST ST SW | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 559050001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5073776285 | ||||||||
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| Practice Location | |||||||||
| Address1: | 32021 COUNTY 24 BLVD | ||||||||
| Address2: | |||||||||
| City: | CANNON FALLS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550095003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5073776285 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2006 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 45662 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 431T7BE | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER | 6607467 | 01 | MN | MEDICA URGENT CARE | OTHER | NA4431034911 | 01 | MN | PREFERREDONE | OTHER | 418911600 | 05 | MN | MEDICAID | 0121330 | 01 | MN | MEDICA - CLINIC | OTHER | HP39649 | 01 | MN | HEALTHPARTNERS | OTHER |