Healthcare Provider Details

I. General information

NPI: 1891235800
Provider Name (Legal Business Name): DEKALB HEALTH MEMORIAL HOSPTIAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2017
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 W. SEVENTH ST.
AUBURN IN
46706-2013
US

IV. Provider business mailing address

916 W. SEVENTH ST.
AUBURN IN
46706-2013
US

V. Phone/Fax

Practice location:
  • Phone: 260-920-2501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: CRAIG POLKOW
Title or Position: CEO
Credential:
Phone: 260-920-2501