Organization
GRANGER MEDICAL CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY JANE PENNINGTON M.D. (PRESIDENT)
(801) 965-3417
Entity
Organization
Contact information
Practice address
2965 W. 3500 S., WEST VALLEY CITY, UT 84119
(801) 965-3600
Mailing address
2965 W 3500 S, WEST VALLEY CITY, UT 84119-3602
(801) 965-3600
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
208000000X
Pediatrics Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
—
—
2084N0400X
Neurology Physician
—
—
208600000X
Surgery Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
07/07/2006
Last updated
12/13/2023
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