1841487980 NPI number — HOME DELIVERY INCONTINENT SUPPLIES CO INC

Table of content: (NPI 1841487980)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841487980 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:
1841487980
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 DR
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:
314-997-8771
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 DR
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:
314-997-8771
Provider Business Practice Location Address Fax Number:
888-874-4347
Provider Enumeration Date:
10/03/2007

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: 2167408 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02056215 , issued by the state of ( NY ) . 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: 1559334 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9028242 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015365201 , 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: 010070724 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0543678 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 628652307 , issued by the state of ( MO ) . 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".
  • 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".




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