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General NPI Number Information
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NPI Number | 1073886560
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Entity Type | Organization
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Legal Business Name | DEKALB MEMORIAL HOSPITAL, INC
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Dates
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Enumeration Date | 02/15/2012
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Last Update Date | 09/13/2016
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Provider Practice Location Address
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Address Line | 1310 E 7TH ST SUITE G
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City | AUBURN
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State | IN
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Zip | 46706-2534
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Country | US
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Telephone | 260-920-2000
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Fax | 260-920-2005
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Provider Business Mailing Address
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Address Line | PO BOX 623
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City | AUBURN
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State | IN
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Zip | 46706-0623
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Country | US
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Telephone | 260-927-8105
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Fax | 260-927-8026
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Authorized Official
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Title or Position | CEO
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Name | CRAIG POLKOW
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Credential |
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Telephone | 260-925-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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