NPIMap

Organization Active NPI

Dekalb Memorial Hospital Inc

  • Otolaryngology Physician
  • Auburn, IN
National Provider Identifier
1255875712
Registry record updated Dec 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
01039551A Issued in IN
Legal business name
DEKALB MEMORIAL HOSPITAL INC
Practice address
1310 E 7TH St
Ste B
Auburn, IN 46706-2534
Phone
(260) 920-2501
NPI assigned
Dec 16, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Craig Polkow
Title
Ceo
Phone
(260) 920-2501

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Y00000X 01039551A IN Primary
AudiologistGroup: 193200000X MULTI-SPECIALTY GROUP 231H00000X 23001905A IN

Addresses

Primary practice location

1310 E 7TH St
Ste B
Auburn, IN 46706-2534

Mailing address

PO Box 623
Auburn, IN 46706-0623

Other identifiers 1

IdentifierTypeStateIssuer
191560OtherINMEDICARE PTAN

Other names 1

  • Dekalb Health Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dekalb Memorial Hospital4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1481846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481846400000",
    "number": "1255875712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 623",
            "city": "AUBURN",
            "state": "IN",
            "postal_code": "467060623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 E 7TH ST",
            "address_2": "STE B",
            "city": "AUBURN",
            "state": "IN",
            "postal_code": "467062534",
            "telephone_number": "260-920-2501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEKALB MEMORIAL HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-16",
        "last_updated": "2016-12-16",
        "status": "A",
        "authorized_official_last_name": "POLKOW",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "260-920-2501"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "IN",
            "license": "01039551A",
            "primary": true
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist",
            "state": "IN",
            "license": "23001905A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "191560",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dekalb Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Auburn, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.