NPIMap

Organization Active NPI

Home Delivery Incontinent Supplies Co Inc

  • Durable Medical Equipment & Medical Supplies
  • Texarkana, AR
National Provider Identifier
1104167352
Registry record updated Apr 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
HOME DELIVERY INCONTINENT SUPPLIES CO INC
Practice address
4613 Parkway Dr
Suite a
Texarkana, AR 71854-1142
Phone
(800) 367-8360
NPI assigned
Mar 13, 2013
Organization subpart
Yes
Parent organization
JOURNEY DPC CORPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brad Goodwin
Title
President
Phone
(314) 997-8771

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

4613 Parkway Dr
Suite a
Texarkana, AR 71854-1142

Mailing address

9385 Dielman Industrial Dr
Olivette, MO 63132-2214
Phone (314) 997-8771

Other identifiers 3

IdentifierTypeStateIssuer
330741501MedicaidTX
330741503MedicaidTX
330741502MedicaidTX

Other names 1

  • HDIS Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130904000436 AR DME Supplier - Medical Supply Company 5193844439 Practice locations: Texarkana, AR

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Home Delivery Incontinent Supplies4613 Parkway Drive, Texarkana, AR 71854-1142(855) 879-2114 Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Neuromuscular Elect Stimulators (NMES)/Supplies|Support Surfaces: Pressure Reducing Beds/Mats/Pads|(TENS) Transcutaneous Electrical Nerve Stimulators and/or Supplies|Canes and/or Crutches|Seat Lift Mech… Does not accept assignmentParticipating since Dec 3, 2010

National Provider Directory

National Provider Directory
Tax ID family
Home Delivery Incontinent Supplies Co Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4613 Parkway Dr
Ste A
Texarkana, AR 71854
Phone (800) 367-8360

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1363132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745366400000",
    "number": "1104167352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9385 DIELMAN INDUSTRIAL DR",
            "city": "OLIVETTE",
            "state": "MO",
            "postal_code": "631322214",
            "telephone_number": "314-997-8771",
            "fax_number": "314-997-0997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4613 PARKWAY DR",
            "address_2": "SUITE A",
            "city": "TEXARKANA",
            "state": "AR",
            "postal_code": "718541142",
            "telephone_number": "800-367-8360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOME DELIVERY INCONTINENT SUPPLIES CO INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JOURNEY DPC CORP",
        "enumeration_date": "2013-03-13",
        "last_updated": "2025-04-23",
        "certification_date": "2025-04-23",
        "status": "A",
        "authorized_official_last_name": "GOODWIN",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-997-8771"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "330741501",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "330741503",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "330741502",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HDIS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Texarkana, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.