Organization Name: | SHOPKO STORES OPERATING CO LLC |
NPI Number: | 1700042884 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL BETTIGA (SR. VICE PRESIDENT HEALTH SERVICES) |
Mailing Address: | 3271 Marketplace Dr Council Bluffs |
State: | IA US |
Postal Code: | 51501 |
Phone Number: | 7123660377 |
Fax Number: | 7123669020 |
NPI Enumeration Date: | 07/29/2008 |
NPI Last Update Date: | 05/13/2009 |
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 |