Provider Demographics
NPI:1285631259
Name:DEK HEALTH ALLIANCE
Entity Type:Organization
Organization Name:DEK HEALTH ALLIANCE
Other - Org Name:APPALACHIAN MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-256-4013
Mailing Address - Street 1:PO BOX 929
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456-0929
Mailing Address - Country:US
Mailing Address - Phone:606-256-4013
Mailing Address - Fax:606-256-1242
Practice Address - Street 1:45 NEWCOMB AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456-2732
Practice Address - Country:US
Practice Address - Phone:606-256-4013
Practice Address - Fax:606-256-1242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000334076OtherBLUE CROSS BLUE SHIELD
KY90007998Medicaid
KY5054880001Medicare ID - Type Unspecified