Provider Demographics
NPI:1326095985
Name:DELTA MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:DELTA MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-638-8368
Mailing Address - Street 1:11734 LACKLAND INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4209
Mailing Address - Country:US
Mailing Address - Phone:314-423-3165
Mailing Address - Fax:314-423-3143
Practice Address - Street 1:11734 LACKLAND INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4209
Practice Address - Country:US
Practice Address - Phone:314-423-3165
Practice Address - Fax:314-423-3143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO625094503Medicaid
MO133460OtherBC/BS
MO3913350001Medicare NSC