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General NPI Number Information
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NPI Number | 1881797876
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Entity Type | Organization
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Legal Business Name | GRANGER MEDICAL CLINIC INC
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 05/13/2013
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Provider Practice Location Address
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Address Line | 12391 S 4000 W
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City | RIVERTON
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State | UT
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Zip | 84096-7012
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Country | US
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Telephone | 801-302-1700
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Fax | 801-302-1714
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Provider Business Mailing Address
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Address Line | 12391 S 4000 W
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City | RIVERTON
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State | UT
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Zip | 84096-7012
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Country | US
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Telephone | 801-302-1700
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Fax | 801-302-1714
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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 | MD
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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 | 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 #2
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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 #3
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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 #4
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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 #5
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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 #6
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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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 | 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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