Provider Demographics
NPI:1114938859
Name:GRAHAM HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:GRAHAM HOSPITAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE/CFO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-647-5240
Mailing Address - Street 1:101 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:IL
Mailing Address - Zip Code:61520-2607
Mailing Address - Country:US
Mailing Address - Phone:309-647-5240
Mailing Address - Fax:309-649-5110
Practice Address - Street 1:101 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:IL
Practice Address - Zip Code:61520-2607
Practice Address - Country:US
Practice Address - Phone:309-647-5240
Practice Address - Fax:309-649-5110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000310332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016564OtherHEALTH ALLIANCE
IL0002915611OtherBLUE CROSS BLUE SHIELD IL
IL016564OtherHEALTH ALLIANCE
IL0575450001Medicare NSC
IL0002915611OtherBLUE CROSS BLUE SHIELD IL