Healthcare Provider Details

I. General information

NPI: 1144016197
Provider Name (Legal Business Name): GRAHAM HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 N 5TH AVE
CANTON IL
61520-2800
US

IV. Provider business mailing address

210 W WALNUT ST
CANTON IL
61520-2444
US

V. Phone/Fax

Practice location:
  • Phone: 309-647-0201
  • Fax:
Mailing address:
  • Phone: 309-647-5240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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