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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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