Healthcare Provider Details

I. General information

NPI: 1780692087
Provider Name (Legal Business Name): GRAHAM HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W WALNUT ST
CANTON IL
61520-2497
US

IV. Provider business mailing address

210 W WALNUT ST
CANTON IL
61520-2444
US

V. Phone/Fax

Practice location:
  • Phone: 309-647-5240
  • Fax:
Mailing address:
  • Phone: 309-647-5240
  • Fax: 309-649-5110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: JULIE REEDER
Title or Position: VP OF FINANCE/CFO
Credential:
Phone: 309-647-5240