=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568947737
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRACEMED HEALTH CLINIC, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2018
-----------------------------------------------------
Last Update Date | 09/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 E ROSS ST
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67026-7824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-866-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1150 N BROADWAY AVE
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67214-2805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-866-2000
-----------------------------------------------------
Fax | 316-866-2084
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JULIE ELDER
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 316-866-2066
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------