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GRANGER MEDICAL CLINIC PC
NPI 1073811733
Clinic/Center - Multi-Specialty in Tooele, UT

Active since March 04, 2011CLIA Certified · 2 labs
2356 N 400 E STE 201, TOOELE, UT 84074(801) 352-5900(801) 352-5914 Get Directions Write a Review

NPPES record last updated: December 13, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Granger Medical Clinic Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GRANGER MEDICAL CLINIC PC (NPI 1073811733) is a healthcare organization registered as a multi-specialty in Tooele, Utah and active in the NPI registry since March 2011. The organization holds 2 active CLIA laboratory certificates and lists Mary Jane Pennington, President, as its authorized official.

NPPES Registry Identity

NPI1073811733
Entity TypeOrganization
Primary Taxonomy261QM1300X
Legal Business NameGRANGER MEDICAL CLINIC PC
Location Address2356 N 400 E STE 201Tooele, UT 84074-3409
Mailing Address2965 W 3500 SWest Valley City, UT 84119-3602 · (801) 965-3600
Phone(801) 352-5900
Fax(801) 352-5914
Organization SubpartYes
Authorized OfficialMary Jane PenningtonPresident · (801) 965-3600
Enumeration DateMarch 4, 2011
Last NPPES UpdateDecember 13, 2023
NPPES CertifiedDecember 13, 2023
✔ NPI 1073811733 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Multi-SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM1300X
2356 N 400 E STE 201, Tooele, UT 84074
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CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 46D2157488

Granger Medical Fairbourne · West Valley City, UT
Active · expires Mar 20, 2028
CLIA Number46D2157488
Laboratory TypePhysician Office
Certificate Effective DateMarch 21, 2026
Certificate Expiration DateMarch 20, 2028
Laboratory DirectorSean D. Peterson
Laboratory Phone(801) 965-3600
Laboratory LocationGranger Medical Fairbourne2965 W 3500 S, West Valley City, UT 84119
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Certificate of Waiver 46D2124743

Granger Medical Clinic Tooele · Tooele, UT
Active · expires Jan 23, 2027
CLIA Number46D2124743
Laboratory TypePhysician Office
Certificate Effective DateJanuary 24, 2025
Certificate Expiration DateJanuary 23, 2027
Laboratory DirectorCorey Neerings
Laboratory Phone(435) 843-4406
Laboratory LocationGranger Medical Clinic Tooele2326 N 400 E Bldg C, Suite 203, Tooele, UT 84074
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JUSTIN M COX PA-C
Physician Assistant
2356 N 400 E STE 201
TOOELE, UT 84074
Tooele County (435) 882-2350
AMANDA L SHEFFER APRN
Nurse Practitioner (Family)
2356 N 400 E STE 201
TOOELE, UT 84074
Tooele County (435) 882-2350

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Granger Medical Clinic PC's NPI number?

The NPI number for Granger Medical Clinic PC is 1073811733. It was assigned to this organization in the NPPES registry on March 4, 2011.

Where is Granger Medical Clinic PC located?

Granger Medical Clinic PC is located at 2356 N 400 E Ste 201, Tooele, UT 84074. The listed phone number is (801) 352-5900.

What is Granger Medical Clinic PC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.

Does Granger Medical Clinic PC hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Granger Medical Clinic PC was last updated on December 13, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.