# GRANGER MEDICAL CLINIC, PC

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

## Provider details

- **NPI number:** 1649541699
- **Legal business name:** GRANGER MEDICAL CLINIC, PC
- **Authorized official:** MRS. ANNE WHITAKER (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (801) 965-3505

## Contact information

- **Practice address:** 1288 W 12700 S, RIVERTON, UT 84065-6794
- **Practice address phone:** (801) 253-3500
- **Practice address fax:** (801) 253-5859
- **Mailing address:** 3725 W 4100 S, WEST VALLEY CITY, UT 84120-5530
- **Mailing address phone:** (801) 965-3505

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |

## Other

- **Enumeration date:** 01/23/2012
- **Last updated:** 03/02/2015