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NPI Code Detail

MEDICARE: GRANGER MEDICAL SPECIALISTS LLC

MEDICARE: GRANGER MEDICAL SPECIALISTS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1770224453
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRANGER MEDICAL SPECIALISTS LLC
Provider Business Mailing Address
First Line : 7181 S CAMPUS VIEW DR STE 200
Second Line :
City : WEST JORDAN
State : UT
Zip : 84084-4312
Country : US
Telephone Number : 801-965-3505
Fax Number :
Provider Business Practice Location Address
First Line : 9844 S 1300 E STE 100
Second Line :
City : SANDY
State : UT
Zip : 84094-4600
Country : US
Telephone Number : 801-571-9433
Fax Number :
Authorized Official
Title or Position : PRESIDENT/CEO
Name : MARY JANE PENNINGTON
Credential : MD
Telephone Number : 801-965-3600
Provider Enumeration Date : 04/05/2022
Last Update Date : 04/05/2022

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Directions to “GRANGER MEDICAL SPECIALISTS LLC ” Practice Location

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