Organization
GRANGER MEDICAL CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY JANE PENNINGTON M.D. (BOARD MEMBER)
(801) 965-3600
Entity
Organization
Contact information
Practice address
348 E 4500 S, SUITE 200, SALT LAKE CITY, UT 84107-3906
(801) 262-9800
(801) 262-8300
Mailing address
3725 W 4100 S, WEST VALLEY CITY, UT 84120-5530
(801) 965-3600
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
164813-1205
UT
Other
Enumeration date
10/24/2006
Last updated
12/10/2015
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