Provider Demographics
NPI:1902232200
Name:DEKALB HEALTH
Entity Type:Organization
Organization Name:DEKALB HEALTH
Other - Org Name:DEKALB HEALTH MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING/COLLECTION MANAGER
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:260-920-2794
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:260-927-8026
Practice Address - Street 1:1314 E 7TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-2535
Practice Address - Country:US
Practice Address - Phone:260-920-2894
Practice Address - Fax:260-920-2880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-18
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN191560Medicare PIN