Organization
GRANGER MEDICAL CLINIC INC
Active
Parent organization
GRANGER MEDICAL CLINIC INC
Other names
Granger Medical Riverton
Organization subpart
Yes
Provider details
NPI number
Legal business name
GRANGER MEDICAL CLINIC INC
Authorized official
DR. MARY JANE PENNINGTON MD (PRESIDENT)
(801) 965-3417
Entity
Organization
Contact information
Practice address
12391 S 4000 W, RIVERTON, UT 84096-7012
(801) 302-1700
(801) 302-1714
Mailing address
12391 S 4000 W, RIVERTON, UT 84096-7012
(801) 302-1700
(801) 302-1714
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
213E00000X
Podiatrist
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
09/06/2006
Last updated
05/13/2013
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