MEDICARE: GRAHAM HOSPITAL ASSOCIATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1841146453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAHAM HOSPITAL ASSOCIATION

Provider Business Mailing Address
First Line	:	210 W WALNUT ST
Second Line	:
City	:	CANTON
State	:	IL
Zip	:	61520-2497
Country	:	US
Telephone Number	:	309-647-5240
Fax Number	:

Provider Business Practice Location Address
First Line	:	GMG SOUTH - PRIMARY & CONVENIENT CARE
Second Line	:	455 E 3RD ST
City	:	GALESBURG
State	:	IL
Zip	:	61401
Country	:	US
Telephone Number	:	309-570-1333
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	JULIE REEDER
Credential	:
Telephone Number	:	309-647-5240

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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