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Contact Information

SHOPKO STORES OPERATING CO LLC
1209 18TH AVE NW
AUSTIN, MN55912-1881
 Phone: 507-437-7616
 Fax: 507-437-8565
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
 

Eyewear Supplier

332H00000X 87 All Other Suppliers
Indicates primary specialty

NPI Profile & details for SHOPKO STORES OPERATING CO LLC

NPI # 1265486039
LBN Legal business name SHOPKO STORES OPERATING CO LLC
Authorized official MICHAEL BETTIGA - (SR. VICE PRESIDENT HEALTH SERVICES)
Entity Organization
Organization subpart 1 No
Enumeration date 05/19/2006
Last updated 08/27/2013 - About 13 years ago
Identifiers
MN License # 2628024
IA Medicaid 0578674
MN Medicaid 126023500
MN Medicaid 608057000
MN Medicaid 840020000
Other 2416116 NCPDP NUMBER
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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