Provider Demographics
NPI:1669421624
Name:DEK HEALTH ALLIANCE LLC
Entity type:Organization
Organization Name:DEK HEALTH ALLIANCE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIDD
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:606-256-4013
Mailing Address - Street 1:PO BOX 929
Mailing Address - Street 2:45 NEWCOMB AVENUE
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 1:127 KINGSWOOD DR
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-9634
Practice Address - Country:US
Practice Address - Phone:270-469-1335
Practice Address - Fax:270-469-1336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYMG0543332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCO8405418OtherDMERC SUBMITTER M/C EDI
KY90007998Medicaid
KY5054880001Medicare NSC