| Granger Medical Specialists, Llc | |
|
6322 S 3000 E Ste 100 Salt Lake City UT 84121-6931 | |
| (801) 352-5900 | |
| Not Available |
| Full Name | Granger Medical Specialists, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6322 S 3000 E Ste 100, Salt Lake City, Utah |
| Authorized Official Name and Position | Mary Jane Pennington (PRESIDENT/CEO) |
| Authorized Official Contact | 8019653600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Granger Medical Specialists, Llc 7181 S Campus View Dr Ste 200 West Jordan UT 84084-4312 Ph: (801) 965-3505 | Granger Medical Specialists, Llc 6322 S 3000 E Ste 100 Salt Lake City UT 84121-6931 Ph: (801) 352-5900 |
| NPI Number | 1497441539 |
|---|---|
| Provider Enumeration Date | 04/12/2023 |
| Last Update Date | 04/12/2023 |
| Medicare PECOS PAC ID | 4587074356 |
|---|---|
| Medicare Enrollment ID | O20230601002054 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497441539 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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