Healthcare Provider Details

I. General information

NPI: 1508463563
Provider Name (Legal Business Name): GRAHAM HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E GALE ST
WILLIAMSFIELD IL
61489-5418
US

IV. Provider business mailing address

180 S MAIN ST
CANTON IL
61520-2608
US

V. Phone/Fax

Practice location:
  • Phone: 309-639-4004
  • Fax: 309-639-4065
Mailing address:
  • Phone: 309-647-0201
  • Fax: 309-647-8613

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: JANELLE M POSTIN
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 309-647-5240