Provider Demographics
NPI:1982901583
Name:NORTH DELTA MEDICAL SUPPLIES, INC
Entity Type:Organization
Organization Name:NORTH DELTA MEDICAL SUPPLIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:E
Authorized Official - Last Name:VALLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-795-5949
Mailing Address - Street 1:3949 WHITEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-3727
Mailing Address - Country:US
Mailing Address - Phone:901-795-5949
Mailing Address - Fax:901-795-5859
Practice Address - Street 1:3955 WHITEBROOK DR STE 2
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-3745
Practice Address - Country:US
Practice Address - Phone:901-795-5949
Practice Address - Fax:901-795-5859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN216251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS251629Medicare Oscar/Certification
TN447261Medicare Oscar/Certification