Healthcare Provider Details

I. General information

NPI: 1255768008
Provider Name (Legal Business Name): DEKALB MEMORIAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2013
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 E 7TH ST SUITE A
AUBURN IN
46706-2536
US

IV. Provider business mailing address

PO BOX 623
AUBURN IN
46706-0623
US

V. Phone/Fax

Practice location:
  • Phone: 260-925-1255
  • Fax: 260-925-1256
Mailing address:
  • Phone: 260-925-1255
  • Fax: 260-925-1256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. PENNY LYNN GRIFFIN
Title or Position: BILLING/COLLECTION MANAGER
Credential: CPC
Phone: 260-920-2794