| Organization Name: | GRANGER MEDICAL CLINIC PC |
| NPI Number: | 1356425672 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY JANE PENNINGTON (BOARD MEMBER) |
| Mailing Address: | 348 E 4500 S Suite 200 Salt Lake City |
| State: | UT US |
| Postal Code: | 841073906 |
| Phone Number: | 8012629800 |
| Fax Number: | 8012628300 |
| NPI Enumeration Date: | 10/24/2006 |
| NPI Last Update Date: | 12/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 164813-1205 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |