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Contact Information

SHOPKO STORES OPERATING CO LLC
1900 N MAIN ST
MITCHELL, SD57301-1160
 Phone: 605-996-6568
 Fax: 605-996-6627
 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 # 1457302028
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 05/16/2006
Last updated 06/06/2014 - About 12 years ago
Identifiers
SD License # 1001905
SD Medicaid 8500490
SD Medicaid 8500492
SD Medicaid 9164970
SD Medicaid 9164972
Other 4300505 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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