Healthcare Provider Details

I. General information

NPI: 1134057896
Provider Name (Legal Business Name): GRAHAM HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W JACKSON ST
MACOMB IL
61455-3176
US

IV. Provider business mailing address

210 W WALNUT ST
CANTON IL
61520-2497
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIE REEDER
Title or Position: CFO
Credential:
Phone: 309-647-5240