NPIMap

Organization Active NPI

Granger Medical Clinic PC

  • Medical Specialty Clinic/Center
  • Sandy, UT
National Provider Identifier
1871320028
Registry record updated Sep 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
Legal business name
GRANGER MEDICAL CLINIC PC
Practice address
9844 S 1300 E Ste 100
Sandy, UT 84094-4600
Phone
(801) 965-3600
NPI assigned
Sep 19, 2024
Last updated
Sep 19, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
GRANGER MEDICAL CLINIC PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mary Jane Pennington, MDNPI 1205868452
Title
President
Phone
(801) 965-3600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X Primary

Addresses

Primary practice location

9844 S 1300 E Ste 100
Sandy, UT 84094-4600

Mailing address

2965 W 3500 S
West Valley City, UT 84119-3602
Phone (801) 965-3505

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251118002549 UT DME Supplier - Multi-Specialty - Physician 3476465691 Practice locations: Sandy, UT

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Granger Medical Clinica7 organizations share this tax ID, including this one
Part of
Granger Medical Clinica

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1551 Renaissance Towne Dr
Ste 370
Bountiful, UT 84010
Phone (801) 292-4425

11724 S State St
Draper, UT 84020
Phone (801) 576-2000

999 E Murray Holladay Rd
Millcreek, UT 84117
Phone (801) 268-2584

181 E 5600 S
Ste 130
Murray, UT 84107
Phone (801) 266-8664

5444 S Green St
#201
Murray, UT 84123
Phone (801) 281-1300

8178 Gorgoza Pines Rd
Unit 8H
Park City, UT 84098
Phone (801) 747-7244

5323 S Woodrow St
Ste 201
Salt Lake City, UT 84107
Phone (801) 261-4711

9600 S 1300 E
Ste 240
Sandy, UT 84094
Phone (801) 571-5121

2326 N 400 E
#C203
Tooele, UT 84074
Phone (435) 843-4406

2326 N 400 E
Ste C203
Tooele, UT 84074
Phone (435) 843-4406

2376 N 400 E
Ste 203
Tooele, UT 84074
Phone (435) 882-0599

71 E 1280 N
Tooele, UT 84074
Phone (801) 260-5864

2751 W 9000 S
West Jordan, UT 84088
Phone (801) 352-5900

9001 S 3200 W
West Jordan, UT 84088
Phone (801) 569-5520

Practitioners & affiliated clinicians

Practitioners 125

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 125

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1726704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726704000000",
    "number": "1871320028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2965 W 3500 S",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841193602",
            "telephone_number": "801-965-3505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9844 S 1300 E STE 100",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840944600",
            "telephone_number": "801-965-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANGER MEDICAL CLINIC PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRANGER MEDICAL CLINIC PC",
        "enumeration_date": "2024-09-19",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A",
        "authorized_official_last_name": "PENNINGTON",
        "authorized_official_first_name": "MARY JANE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-965-3600",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandy, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.