Healthcare Provider Details

I. General information

NPI: 1720907223
Provider Name (Legal Business Name): GRANITE PEAKS ENDOSCOPY SURGICENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10150 S PETUNIA WAY STE B
SANDY UT
84092-4328
US

IV. Provider business mailing address

10150 S PETUNIA WAY STE B
SANDY UT
84092-4328
US

V. Phone/Fax

Practice location:
  • Phone: 801-619-1115
  • Fax:
Mailing address:
  • Phone: 801-619-1115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID MCKNIGHT
Title or Position: VP/CFO
Credential:
Phone: 972-789-2816