Provider Demographics
NPI:1295730919
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:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:BRET
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAGHORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-927-5012
Mailing Address - Street 1:1316 E SEVENTH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-0583
Mailing Address - Country:US
Mailing Address - Phone:260-925-8699
Mailing Address - Fax:260-925-9042
Practice Address - Street 1:400 ERIE PASS
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-0000
Practice Address - Country:US
Practice Address - Phone:260-925-8699
Practice Address - Fax:260-925-9042
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEKALB MEMORIAL HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-17
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN009702251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200139550AMedicaid
IN151559Medicare Oscar/Certification