Provider Demographics
NPI:1932674678
Name:HOME DELIVERY INCONTINENT SUPPLIES CO.
Entity Type:Organization
Organization Name:HOME DELIVERY INCONTINENT SUPPLIES CO.
Other - Org Name:PROFESSIONAL MEDICAL FULFILLMENT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT OF HDIS
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKS
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 1:2403 S UNIROYAL RD
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36804-8325
Practice Address - Country:US
Practice Address - Phone:877-516-4582
Practice Address - Fax:334-737-0100
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOME DELIVERY INCONTINENT SUPPLIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-09
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies