# GRANGER MEDICAL CLINIC, INC.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** GRANGER MEDICAL CLINIC, INC.
- **Other names:** Granger Medical Clinic - Wasatch
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1629163746
- **Legal business name:** GRANGER MEDICAL CLINIC, INC.
- **Authorized official:** ANNE M WHITAKER (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (801) 965-3505

## Contact information

- **Practice address:** 1160 E 3900 S, SUITE 1000, SALT LAKE CITY, UT 84124-1202
- **Practice address phone:** (801) 262-1771
- **Practice address fax:** (801) 288-9101
- **Mailing address:** 1160 E 3900 S, SUITE 1000, SALT LAKE CITY, UT 84124-1202
- **Mailing address phone:** (801) 262-1771
- **Mailing address fax:** (801) 288-9101

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 870526286 | UT | Yes |

## Other

- **Enumeration date:** 10/04/2006
- **Last updated:** 08/16/2016