| Grace Clinic Health Professional | |
|
622 8th Avenue Terre Haute IN 47804-4780 | |
| (812) 231-8200 | |
| Not Available |
| Full Name | Grace Clinic Health Professional |
|---|---|
| Speciality | Clinic/Center |
| Location | 622 8th Avenue, Terre Haute, Indiana |
| Authorized Official Name and Position | Melvin L Burks (PRESIDENT/CEO) |
| Authorized Official Contact | 8122318296 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Clinic Health Professional 620 8th Ave Terre Haute IN 47804-2771 Ph: (812) 231-8200 | Grace Clinic Health Professional 622 8th Avenue Terre Haute IN 47804-4780 Ph: (812) 231-8200 |
| NPI Number | 1205446259 |
|---|---|
| Provider Enumeration Date | 08/05/2020 |
| Last Update Date | 08/23/2023 |
| Certification Date | 08/23/2023 |
| Medicare PECOS PAC ID | 4284533662 |
|---|---|
| Medicare Enrollment ID | O20201001001910 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205446259 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | () | Primary |
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