Provider Demographics
NPI:1083758320
Name:GRANITE PEAKS ENDOSCOPY,LLC
Entity Type:Organization
Organization Name:GRANITE PEAKS ENDOSCOPY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-619-9000
Mailing Address - Street 1:10150 S PETUNIA WAY STE B
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-4328
Mailing Address - Country:US
Mailing Address - Phone:801-619-9000
Mailing Address - Fax:801-619-9000
Practice Address - Street 1:10150 SOUTH PETUNIA WAY
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84092-4380
Practice Address - Country:US
Practice Address - Phone:801-619-9000
Practice Address - Fax:801-619-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical