GRACEMED EVERGREEN FAMILY CLINIC (NPI# 1912333774) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1912333774 |
Entity Type | Organization |
Organization Name | GRACEMED EVERGREEN FAMILY CLINIC |
Practice Address |
2700 N Woodland St Wichita KS 67204-5158 |
Mailing Address |
1122 N Topeka St Wichita KS 67214-2810 |
Practice Telephone | 3168662000 |
Practice Fax Number | 3168662084 |
Mailing Telephone | 3168662000 |
Mailing Fax Number | 3168662084 |
Enumeration Date | 2013-09-24 |
Last Update Date | 2013-09-24 |
Authorized Official Name | MR. DAVID C SANFORD (CEO) |
Authorized Official Telephone | 3168662001 |
Is Organization Subpart | Y |
Parent Organization Name | GRACEMED HEALTH CLINIC, INC |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
KS | 100212250A | 05 |
Street Address |
2700 N WOODLAND ST |
City | WICHITA |
State | KS |
Zip Code | 67204-5158 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1952570657 | Wal-mart Store, Inc. | Eyewear Supplier (Equipment, not the service) | 5475 N. Meridian, Wichita, KS 67204 | 2008-02-27 |
1992907141 | Diane Jeanette Casey | Physical Therapist | 2812 W 61 St N, Rehab & Consulting Pa, Wichita, KS 67204 | 2007-06-01 |
1477534030 | Yvonne Lara Saunders-teigeler | Family Medicine | 3443 North Amidon Avenue, Wichita, KS 67204 | 2005-11-10 |
1487836110 | Walmart Inc. | Durable Medical Equipment & Medical Supplies | 5475 N Meridian Ave, Wichita, KS 67204-1620 | 2007-12-05 |
1083152540 | Ray Tejeda | Pharmacist | 5475 N Meridian Ave, Wichita, KS 67204-1620 | 2017-02-05 |
1265989305 | Sanjiv Patel | Pharmacist | 5475 N Meridian Ave, Wichita, KS 67204-1620 | 2016-09-07 |
1962618041 | Laquita Riley | Physical Therapist | 5701 N Sedgwick St, Wichita, KS 67204-1831 | 2007-05-15 |
1417276791 | House Call Medical Services | Nurse Practitioner | 5721 N Athenian Ave, Wichita, KS 67204-1844 | 2010-05-25 |
1710008495 | Home Care Equipment, Inc. | Durable Medical Equipment & Medical Supplies | 703 W 53rd St N, Wichita, KS 67204-2237 | 2007-04-02 |
1962903906 | Nalini Fraser | Pharmacist | 2806 W Driftwood Cir, Wichita, KS 67204-2340 | 2018-02-26 |
Find all providers in zip 67204 |
Taxonomy Code | 261QF0400X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Federally Qualified Health Center (FQHC) |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1932579513 | Gracemed Health Clinic, Inc | Clinic/Center | 755 W. Lincoln St, Wichita, KS 67213 | 2015-09-25 |
1992113898 | Gracemed Health Clinic, Inc | Clinic/Center | 5000 S Clifton Ave Ste 200, Wichita, KS 67216-3408 | 2014-07-24 |
1043646870 | Gracemed Downing Children Clinic | Clinic/Center | 2201 E 25th St N, Building 200, Wichita, KS 67219-4714 | 2013-09-25 |
1356777114 | Gracemed Healthy Family Clinic | Clinic/Center | 1905 S Laura St, Wichita, KS 67211-4422 | 2013-09-24 |
1952651713 | Gracemed Health Clinic, Inc | Clinic/Center | 4910 W 1st St N, Wichita, KS 67212-2341 | 2012-09-19 |
1174690796 | Hunter Health Clinic, Inc | Clinic/Center | 935 N Market St, Wichita, KS 67214-3521 | 2006-11-29 |
1265508337 | Hunter Health Clinic, Inc | Clinic/Center | 238 N Waco St, Wichita, KS 67202-1108 | 2006-11-28 |
1841759453 | Hunter Health Clinic, Inc | Clinic/Center | 402 E 2nd St N, Wichita, KS 67202-2504 | 2019-03-14 |
1053770818 | Gracemed Health Clinic, Inc | Clinic/Center | 3417 S Meridian Ave, Wichita, KS 67217-2151 | 2016-02-22 |
1861859787 | Gracemed Health Clinic, Inc | Clinic/Center | 1919 N Amidon Ave, Suite 100, Wichita, KS 67203-2117 | 2016-01-22 |
Find all providers in WICHITA |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.