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NPI Code Detail

MEDICARE: GRANGER MEDICAL CLINIC PC

MEDICARE: GRANGER MEDICAL CLINIC PC
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
1261QM2500XMedical Specialty Clinic/Center

General Provider Information

NPI Number : 1871320028
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRANGER MEDICAL CLINIC PC
Provider Business Mailing Address
First Line : 2965 W 3500 S
Second Line :
City : WEST VALLEY CITY
State : UT
Zip : 84119-3602
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 : 801-965-3600
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MARY JANE PENNINGTON
Credential : MD
Telephone Number : 801-965-3600
Provider Enumeration Date : 09/19/2024
Last Update Date : 09/19/2024

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Directions to “GRANGER MEDICAL CLINIC PC ” Practice Location

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