Granger Medical Clinic PC
NPI 1104857549ActiveOrganization· Clinic/Center, Multi-Specialty· West Jordan, UT
Clinic/Center, Multi-Specialty in West Jordan, Utah, registered in NPPES in July 2006, part of Granger Medical Clinic PC. The authorized official on file is Mary Jane Pennington, MD, President. Enrolled in Medicare as dme supplier - physician - general practice.
Overview
| NPI | 1104857549 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | Granger Medical Clinic PC |
| NPI issued | Jul 5, 2006 |
| Last updated in NPPES | Sep 2, 2025 |
| Certified by provider | Nov 19, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Clinic/Center, Multi-Specialty Primary | 261QM1300X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled DME Supplier - Physician - General Practice (UT) |
|---|
Other Clinic/Center, Multi-Specialty providers in West Jordan
- 1205187325
- 1326789090
- 1689454050
- 1699050823
- 1871225441