# DEKALB MEMORIAL HOSPITAL INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Dekalb Health
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497292452
- **Authorized official:** CRAIG POLKOW (CEO)
- **Authorized official phone:** (260) 920-2501

## Contact information

- **Practice address:** 400 ERIE PASS, AUBURN, IN 46706-2523
- **Practice address phone:** (260) 925-1255
- **Mailing address:** PO BOX 623, AUBURN, IN 46706-0623

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | Yes |
| 363A00000X | Physician Assistant | — | — | Yes |

## Other

- **Enumeration date:** 01/27/2017
- **Last updated:** 01/27/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 191560 | MEDICARE PTAN | IN |