1649383084 NPI number — HOME DELIVERY INCONTINENT SUPPLIES CO INC

Table of content: (NPI 1649383084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649383084 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:
1649383084
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2021
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
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-997-8771
Provider Business Mailing Address Fax Number:
314-997-0997

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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-997-8771
Provider Business Practice Location Address Fax Number:
314-997-0997
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEDVIN
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
314-997-8771

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , 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: 2167408 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8358702 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3408441 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015365201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0543678 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 079035401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 81866300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 98013006 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0005603098 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 118720716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117002300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9028242 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010070724 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 075269301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100013540A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 628652307 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02056215 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 535063800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 805526300 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




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