| Organization Name: | GRANGER MEDICAL TOOELE |
| NPI Number: | 1073811733 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARGARET A ZDUNICH (CREDENTIALING COORDINATOR) |
| Mailing Address: | 2356 N 400 E Ste 201 Tooele |
| State: | UT US |
| Postal Code: | 840743409 |
| Phone Number: | 8013525900 |
| Fax Number: | 8013525914 |
| NPI Enumeration Date: | 03/04/2011 |
| NPI Last Update Date: | 05/13/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |