Provider Demographics
NPI:1427341999
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: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:901-795-4041
Mailing Address - Street 1:3955 WHITEBROOK DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-3727
Mailing Address - Country:US
Mailing Address - Phone:901-795-4041
Mailing Address - Fax:901-795-4036
Practice Address - Street 1:3955 WHITEBROOK DR
Practice Address - Street 2:SUITE 2
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-3745
Practice Address - Country:US
Practice Address - Phone:901-795-4041
Practice Address - Fax:901-795-4036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN216251E00000X
MS137251G00000X
TN1057332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN621194938Medicare Oscar/Certification
MS352283508Medicare Oscar/Certification