GRANGER MEDICAL CLINIC PC NPI 1174968051

NPI Information

  • NPI: 1174968051
  • Provider Name: GRANGER MEDICAL CLINIC PC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Other Name: GRANGER MEDICAL DRAPER
  • CLIA Number: 46D2069689
  • Address: 11724 SOUTH STATE ST.
    DRAPER, UT
    ZIP 84020
  • Phone: (801) 965-3600

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NPI Details

GRANGER MEDICAL CLINIC PC is a family medicine in Draper, UT. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. GRANGER MEDICAL CLINIC PC NPI is 1174968051. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Other Name Is Granger Medical Draper.

The provider's business location address is:

11724 SOUTH STATE ST.
DRAPER, UT
ZIP 84020
Phone: (801) 965-3600
Fax: (801) 965-3740

The provider's authorized official is Mary Jane Pennington .
The authorized official title is President and has the following contact phone number (801) 965-3600.

The CLIA number assigned to this NPI record is 46D2069689 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 5/6/2013 and was last updated on 12/13/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207N00000XDermatologyNo
2207R00000XInternal MedicineNo
3207RG0100XInternal MedicineGastroenterologyNo
4207RN0300XInternal MedicineNephrologyNo
5207RP1001XInternal MedicinePulmonary DiseaseNo
6207RS0010XInternal MedicineSports MedicineNo
7207RS0012XInternal MedicineSleep MedicineNo
8207V00000XObstetrics & GynecologyNo
9207W00000XOphthalmologyNo
10207X00000XOrthopaedic SurgeryNo
11207Y00000XOtolaryngologyNo
12208000000XPediatricsNo
13208200000XPlastic SurgeryNo
14208VP0000XPain MedicinePain MedicineNo
15207Q00000XFamily MedicineYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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