Provider Demographics
NPI:1750527172
Name:GRAHAM HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:GRAHAM HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
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 1:180 S. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:IL
Mailing Address - Zip Code:61520-2608
Mailing Address - Country:US
Mailing Address - Phone:309-647-0201
Mailing Address - Fax:309-649-5302
Practice Address - Street 1:408 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:IL
Practice Address - Zip Code:61542-1563
Practice Address - Country:US
Practice Address - Phone:309-547-9700
Practice Address - Fax:309-547-5926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL143493Medicare Oscar/Certification