1497850879 NPI number — HOME DELIVERY INCONTINENT SUPPLIES CO INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497850879 NPI number — HOME DELIVERY INCONTINENT SUPPLIES CO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOME DELIVERY INCONTINENT SUPPLIES CO INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HDIS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497850879
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9385 DIELMAN INDUSTRIAL DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLIVETTE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63132-2214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-933-0822
Provider Business Mailing Address Fax Number:
888-874-4347

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9385 DIELMAN INDUSTRIAL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLIVETTE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63132-2214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-933-0822
Provider Business Practice Location Address Fax Number:
888-874-4347
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRENCH
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PRESIDENT/CEO
Authorized Official Telephone Number:
314-997-8771

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  B0077345A , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 805526300 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0543678 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100013540A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2167408 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 628652307 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3408441 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0005603098 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 118720716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 98013006 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8358702 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9028242 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02056215 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010070724 , issued by the state of ( VI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117002300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 535063800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 81866300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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