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General NPI Number Information
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NPI Number | 1184657041
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Entity Type | Organization
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Legal Business Name | GRANGER MEDICAL CLINIC PC
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 2965 W. 3500 S.
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City | WEST VALLEY CITY
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State | UT
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Zip | 84119
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Country | US
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Telephone | 801-965-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 2965 W 3500 S
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City | WEST VALLEY CITY
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State | UT
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Zip | 84119-3602
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Country | US
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Telephone | 801-965-3600
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARY JANE PENNINGTON
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Credential | M.D.
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Telephone | 801-965-3417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2082S0105X
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Taxonomy Name | Surgery of the Hand (Plastic Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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