Healthcare Provider Details

I. General information

NPI: 1104167352
Provider Name (Legal Business Name): HOME DELIVERY INCONTINENT SUPPLIES CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4613 PARKWAY DR SUITE A
TEXARKANA AR
71854-1142
US

IV. Provider business mailing address

9385 DIELMAN INDUSTRIAL DR
OLIVETTE MO
63132-2214
US

V. Phone/Fax

Practice location:
  • Phone: 800-367-8360
  • Fax:
Mailing address:
  • Phone: 314-997-8771
  • Fax: 314-997-0997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: BRAD GOODWIN
Title or Position: PRESIDENT
Credential:
Phone: 314-997-8771