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Organization
GRANGER MEDICAL CLINIC PC
Active
Organization
GRANGER MEDICAL CLINIC PC
Active
Parent organization
GRANGER MEDICAL CLINIC PC
Other names
Granger Medical Draper
Organization subpart
Yes
Provider details
NPI number
Legal business name
GRANGER MEDICAL CLINIC PC
Authorized official
MARY JANE PENNINGTON (PRESIDENT)
(801) 965-3600
Entity
Organization
Contact information
Practice address
11724 SOUTH STATE ST., DRAPER, UT 84020
(801) 965-3600
(801) 965-3740
Mailing address
2965 W 3500 S, WEST VALLEY CITY, UT 84119-3602
(801) 965-3600
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
NULL
207N00000X
Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207RG0100X
Gastroenterology Physician
—
NULL
207RG0100X
Gastroenterology Physician
—
—
207RN0300X
Nephrology Physician
—
NULL
207RN0300X
Nephrology Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
NULL
207RP1001X
Pulmonary Disease Physician
—
—
207RS0010X
Sports Medicine (Internal Medicine) Physician
—
NULL
207RS0010X
Sports Medicine (Internal Medicine) Physician
—
—
207RS0012X
Sleep Medicine (Internal Medicine) Physician
—
NULL
207RS0012X
Sleep Medicine (Internal Medicine) Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
NULL
207V00000X
Obstetrics & Gynecology Physician
—
—
207W00000X
Ophthalmology Physician
—
NULL
207W00000X
Ophthalmology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
NULL
207X00000X
Orthopaedic Surgery Physician
—
—
207Y00000X
Otolaryngology Physician
—
NULL
207Y00000X
Otolaryngology Physician
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
208200000X
Plastic Surgery Physician
—
NULL
208200000X
Plastic Surgery Physician
—
—
208VP0000X
Pain Medicine Physician
—
NULL
208VP0000X
Pain Medicine Physician
—
—
Other
Enumeration date
05/06/2013
Last updated
12/13/2023
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