MEDICARE: HOME DELIVERY INCONTINENT SUPPLIES CO INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174839617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME DELIVERY INCONTINENT SUPPLIES CO INC

Provider Business Mailing Address
First Line	:	9385 DIELMAN INDUSTRIAL DR
Second Line	:
City	:	OLIVETTE
State	:	MO
Zip	:	63132-2214
Country	:	US
Telephone Number	:	314-997-8771
Fax Number	:	314-997-0997

Provider Business Practice Location Address
First Line	:	115 E GRANADA BLVD STE 6
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32176-6634
Country	:	US
Telephone Number	:	800-367-8360
Fax Number	:	888-874-4347

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRAD GOODWIN
Credential	:
Telephone Number	:	314-997-8771

Provider Enumeration Date	:	08/22/2010
Last Update Date	:	04/23/2025

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