MEDICARE: DEKALB MEMORIAL HOSPITAL INC

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	251E00000X	Home Health Agency	005332	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033114418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEKALB MEMORIAL HOSPITAL INC

Provider Business Mailing Address
First Line	:	1316 E 7TH ST
Second Line	:
City	:	AUBURN
State	:	IN
Zip	:	46706-2538
Country	:	US
Telephone Number	:	260-925-8699
Fax Number	:	260-925-9042

Provider Business Practice Location Address
First Line	:	400 ERIE PASS
Second Line	:
City	:	AUBURN
State	:	IN
Zip	:	46706-0000
Country	:	US
Telephone Number	:	260-925-8699
Fax Number	:	260-925-9042

Authorized Official
Title or Position	:	BILLING REPRESENTATIVE
Name	:	MRS. PATRICIA A HOFF
Credential	:
Telephone Number	:	260-925-8699

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	01/18/2013

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