MEDICARE: DELTA MEDICAL SUPPLY, 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

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	133460	OTHER	MO	BC/BS

General Provider Information

NPI Number	:	1326095985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELTA MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	11734 LACKLAND INDUSTRIAL DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4209
Country	:	US
Telephone Number	:	314-423-3165
Fax Number	:	314-423-3143

Provider Business Practice Location Address
First Line	:	11734 LACKLAND INDUSTRIAL DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4209
Country	:	US
Telephone Number	:	314-423-3165
Fax Number	:	314-423-3143

Authorized Official
Title or Position	:	OWNER
Name	:	JUNE ELLEN FISCHER
Credential	:
Telephone Number	:	913-638-8368

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	06/10/2021

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