Organization Name: | SHOPKO STORES OPERATING CO LLC |
NPI Number: | 1073565446 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL BETTIGA (EXECUTIVE VICE PRESIDENT AND COO) |
Mailing Address: | 2099 Chatburn Ave Harlan |
State: | IA US |
Postal Code: | 515371845 |
Phone Number: | 7127551112 |
Fax Number: | 7127551369 |
NPI Enumeration Date: | 05/16/2006 |
NPI Last Update Date: | 12/14/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |