MEDICARE: SHOPKO STORES OPERATING CO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4304630	OTHER	NCPDP
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972556926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHOPKO STORES OPERATING CO LLC

Provider Business Mailing Address
First Line	:	2701 HIGHWAY 18 W
Second Line	:
City	:	HOT SPRINGS
State	:	SD
Zip	:	57747-6601
Country	:	US
Telephone Number	:	605-745-4681
Fax Number	:	605-745-4813

Provider Business Practice Location Address
First Line	:	2701 HIGHWAY 18 W
Second Line	:
City	:	HOT SPRINGS
State	:	SD
Zip	:	57747-6601
Country	:	US
Telephone Number	:	605-745-4681
Fax Number	:	605-745-4813

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT & COO
Name	:	MR. MICHAEL BETTIGA
Credential	:	RPH
Telephone Number	:	920-429-4297

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	10/18/2012

Similar Medicare Providers

1437145885 — MARILYN MILNER
Practice Location Address:

2701 HIGHWAY 18 W
HOT SPRINGS, SD
57747-6601

Practice Phone: 605-745-4681
Practice Fax:

1427910330 — SAFE HANDS TRANSIT
Practice Location Address:

862 INDIAN SPRINGS DR
LANCASTER, PA
17601-6601

Practice Phone: 717-617-6735
Practice Fax:

1093799421 — MS. JENETTE K HOLM DPT
Practice Location Address:

928 DIAMOND SPRINGS RD STE 103
VIRGINIA BEACH, VA
23455-6601

Practice Phone: 757-395-1975
Practice Fax: 757-425-7180

1952334484 — SCOTT ANDREW SWANN PT
Practice Location Address:

928 DIAMOND SPRINGS RD STE 103
VIRGINIA BEACH, VA
23455-6601

Practice Phone: 757-395-1975
Practice Fax:

1699866376 — WENDY B JAFFE PT
Practice Location Address:

928 DIAMOND SPRINGS RD STE 103
VIRGINIA BEACH, VA
23455-6601

Practice Phone: 757-395-1975
Practice Fax: 757-425-7180

1790928794 — JANINE MARIE POWER P.T.
Practice Location Address:

928 DIAMOND SPRINGS RD STE 103
VIRGINIA BEACH, VA
23455-6601

Practice Phone: 757-395-1975
Practice Fax: 757-425-7180

Directions to “SHOPKO STORES OPERATING CO LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.