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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 Clinic - Parkway
Organization subpart
Yes
Provider details
NPI number
Legal business name
GRANGER MEDICAL CLINIC, PC
Authorized official
MRS. ANNE WHITAKER (CREDENTIALING COORDINATOR)
(801) 965-3505
Entity
Organization
Contact information
Practice address
1288 W 12700 S, RIVERTON, UT 84065-6794
(801) 253-3500
(801) 253-5859
Mailing address
3725 W 4100 S, WEST VALLEY CITY, UT 84120-5530
(801) 965-3505
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
Other
Enumeration date
01/23/2012
Last updated
03/02/2015
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