Provider Demographics
NPI:1962804559
Name:DEKALB MEMORIAL HOSPITAL, INC
Entity type:Organization
Organization Name:DEKALB MEMORIAL HOSPITAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:260-333-7675
Mailing Address - Street 1:PO BOX 623
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-0623
Mailing Address - Country:US
Mailing Address - Phone:260-927-8105
Mailing Address - Fax:260-333-0664
Practice Address - Street 1:433 W HIGH STREET
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-1679
Practice Address - Country:US
Practice Address - Phone:419-636-1131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty