Provider Demographics
NPI:1427606110
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:
Practice Address - Street 1:1029 OLD CREEK RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8178
Practice Address - Country:US
Practice Address - Phone:800-367-8360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOURNEY DPC CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-27
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies