Fed EIN: 45-4849935
NPI # 1902162811
Medicaid # 06357305
Taxonomy Code: 193200000X

EDI, IDEX Submitter ID: 92089
User Name: TMP978970
Password/User ID: SZZQISRGX
Submission Phone #'s
800-334-2832
800-334-4650

Medicaid
msmedicaid.acs-inc.com
User Name: sddc12
Password: rollingfork1

Gmail:
southdeltadental@gmail.com
rollingfork1

Federal Tax Pin # 7095