| Organization Name: | GRANGER MEDICAL CLINIC INC |
| NPI Number: | 1104857549 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY JANE PENNINGTON (PRESIDENT) |
| Mailing Address: | 3181 W 9000 So West Jordan |
| State: | UT US |
| Postal Code: | 84088 |
| Phone Number: | 8013525900 |
| Fax Number: | 8013525914 |
| NPI Enumeration Date: | 07/05/2006 |
| 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: | |