MEDICARE: GRACEMED HEALTH CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1184691693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACEMED HEALTH CLINIC INC

Provider Business Mailing Address
First Line	:	1150 N BROADWAY AVE
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67214-2805
Country	:	US
Telephone Number	:	316-866-2000
Fax Number	:	316-866-2084

Provider Business Practice Location Address
First Line	:	1122 N TOPEKA ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67214-2810
Country	:	US
Telephone Number	:	316-866-2000
Fax Number	:	316-866-2084

Authorized Official
Title or Position	:	CEO
Name	:	JULIE ELDER
Credential	:	DO
Telephone Number	:	316-866-2066

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	09/08/2025

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