Healthcare Provider Details

I. General information

NPI: 1750527172
Provider Name (Legal Business Name): GRAHAM HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 S. MAIN STREET
LEWISTOWN IL
61542-1563
US

IV. Provider business mailing address

180 S. MAIN STREET
CANTON IL
61520-2608
US

V. Phone/Fax

Practice location:
  • Phone: 309-547-9700
  • Fax: 309-547-5926
Mailing address:
  • Phone: 309-647-0201
  • Fax: 309-649-5302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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