Provider Demographics
NPI:1902897937
Name:DEKALB MEMORIAL HOSPITAL, INC
Entity Type:Organization
Organization Name:DEKALB MEMORIAL HOSPITAL, INC
Other - Org Name:PARKVIEW DEKALB HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:EICHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-920-2500
Mailing Address - Street 1:10501 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1700
Mailing Address - Country:US
Mailing Address - Phone:260-437-7558
Mailing Address - Fax:260-925-4733
Practice Address - Street 1:1316 E 7TH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-2523
Practice Address - Country:US
Practice Address - Phone:260-925-4600
Practice Address - Fax:260-925-4733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039551A207Y00000X
IN23002422A231H00000X
275N00000X, 3416L0300X
IN10-005041-1282N00000X
IN60000349A3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No275N00000XHospital UnitsMedicare Defined Swing Bed UnitGroup - Multi-Specialty
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000097746OtherBLUE CROSS
IN100269460AMedicaid
1562518OtherNCPDP PROVIDER IDENTIFICATION NUMBER
IN100287120AMedicaid
IN100287120AMedicaid