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1902897937

NPI Code Detail

MEDICARE: DEKALB MEMORIAL HOSPITAL, INC

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	275N00000X	Medicare Defined Swing Bed Hospital Unit
2	3416L0300X	Land Ambulance
3	3336I0012X	Institutional Pharmacy	60000349A	IN
4	207Y00000X	Otolaryngology Physician	01039551A	IN
5	231H00000X	Audiologist	23002422A	IN
6	282N00000X	General Acute Care Hospital	10-005041-1	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
2	1562518	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
3	000000097746	OTHER	IN	BLUE CROSS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902897937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEKALB MEMORIAL HOSPITAL, INC

Provider Business Mailing Address
First Line	:	10501 CORPORATE DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1700
Country	:	US
Telephone Number	:	260-437-7558
Fax Number	:	260-925-4733

Provider Business Practice Location Address
First Line	:	1316 E 7TH ST
Second Line	:
City	:	AUBURN
State	:	IN
Zip	:	46706-2523
Country	:	US
Telephone Number	:	260-925-4600
Fax Number	:	260-925-4733

Authorized Official
Title or Position	:	CFO
Name	:	MRS. JESSICA LEE-HANSEN
Credential	:
Telephone Number	:	312-388-0125

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	03/02/2026

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Directions to “DEKALB MEMORIAL HOSPITAL, INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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