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Organization
GRAHAM SERVICES CORPORATION
Active
Organization
GRAHAM SERVICES CORPORATION
Active
Other names
Coleman Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHRIS DUVENDACK (VP OF CLINIC OPERATIONS)
(309) 647-0201
Entity
Organization
Contact information
Practice address
175 S MAIN ST, CANTON, IL 61520-2670
(309) 647-0201
(309) 647-0201
Mailing address
175 S MAIN ST, CANTON, IL 61520-2670
(309) 647-0201
(309) 647-0201
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
IL
207R00000X
Internal Medicine Physician
—
IL
207V00000X
Obstetrics & Gynecology Physician
—
IL
207X00000X
Orthopaedic Surgery Physician
—
IL
208000000X
Pediatrics Physician
—
IL
208600000X
Surgery Physician
—
IL
363L00000X
Nurse Practitioner
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0062839
UMWA
IL
01
—
02922981
BCBS
IL
01
—
200397
BLACK LUNG
IL
01
—
CG5172
RAILROAD MEDICARE
IL
Enumeration date
08/20/2006
Last updated
12/04/2007
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