Provider Demographics
NPI:1841487980
Name:HOME DELIVERY INCONTINENT SUPPLIES CO INC
Entity type:Organization
Organization Name:HOME DELIVERY INCONTINENT SUPPLIES CO INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODWIN
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:888-874-4347
Practice Address - Street 1:9385 DIELMAN INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:OLIVETTE
Practice Address - State:MO
Practice Address - Zip Code:63132-2214
Practice Address - Country:US
Practice Address - Phone:314-997-8771
Practice Address - Fax:888-874-4347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOB0077345A332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02056215Medicaid
LA1559334Medicaid
IA0543678Medicaid
WI81866300Medicaid
WA9028242Medicaid
CO98013006Medicaid
VA010070724Medicaid
TX015365201Medicaid
MO628652307Medicaid
NJ8358702Medicaid
IN100013540AMedicaid
AR118720716Medicaid
OH2167408Medicaid
MD117002300Medicaid
MN535063800Medicaid
WI81866300Medicaid