Provider Demographics
NPI:1649383084
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 DRIVE
Mailing Address - Street 2:
Mailing Address - City:OLIVETTE
Mailing Address - State:MO
Mailing Address - Zip Code:63132
Mailing Address - Country:US
Mailing Address - Phone:314-997-8771
Mailing Address - Fax:314-997-0997
Practice Address - Street 1:9385 DIELMAN INDUSTRIAL DRIVE
Practice Address - Street 2:
Practice Address - City:OLIVETTE
Practice Address - State:MO
Practice Address - Zip Code:63132
Practice Address - Country:US
Practice Address - Phone:314-997-8771
Practice Address - Fax:314-997-0997
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOURNEY DPC CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-17
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO332B00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2167408Medicaid
NJ8358702Medicaid
NC3408441Medicaid
TX015365201Medicaid
IA0543678Medicaid
TX079035401Medicaid
WI81866300Medicaid
CO98013006Medicaid
MT0005603098Medicaid
AR118720716Medicaid
MD117002300Medicaid
WA9028242Medicaid
VA010070724Medicaid
TX075269301Medicaid
IN100013540AMedicaid
MO628652307Medicaid
NY02056215Medicaid
MN535063800Medicaid
ID805526300Medicaid
TX079035401Medicaid
NC3408441Medicaid
ID805526300Medicaid