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General NPI Number Information
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NPI Number | 1669421624
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Entity Type | Organization
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Legal Business Name | DEK HEALTH ALLIANCE LLC
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 127 KINGSWOOD DR
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City | CAMPBELLSVILLE
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State | KY
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Zip | 42718-9634
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Country | US
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Telephone | 270-469-1335
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Fax | 270-469-1336
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Provider Business Mailing Address
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Address Line | PO BOX 929 45 NEWCOMB AVENUE
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City | MOUNT VERNON
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State | KY
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Zip | 40456-0929
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Country | US
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Telephone | 606-256-4013
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Fax | 606-256-1242
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DEBRA S KIDD
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Credential | R.R.T
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Telephone | 606-256-4013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | MG0543
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License Number State | KY
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