Provider Demographics
NPI:1174839617
Name:HOME DELIVERY INCONTINENT SUPPLIES CO INC
Entity Type:Organization
Organization Name:HOME DELIVERY INCONTINENT SUPPLIES CO INC
Other - Org Name:HDIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:NEDVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-997-8771
Mailing Address - Street 1:9385 DIELMAN INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:OLIVETTE
Mailing Address - State:MO
Mailing Address - Zip Code:63132-2214
Mailing Address - Country:US
Mailing Address - Phone:314-997-8771
Mailing Address - Fax:314-997-0997
Practice Address - Street 1:115 E GRANADA BLVD STE 6
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-6634
Practice Address - Country:US
Practice Address - Phone:800-367-8360
Practice Address - Fax:888-874-4347
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOURNEY DPC CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-22
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002960300Medicaid
0677400002Medicare NSC