MEDICARE: FOOD MERCHANTS LLC

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336L0003X	Long Term Care Pharmacy
4	3336S0011X	Specialty Pharmacy
5	3336C0003X	Community/Retail Pharmacy	2003031778	MO

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2048970	OTHER	PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1194767970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOD MERCHANTS LLC

Provider Business Mailing Address
First Line	:	PO BOX 397
Second Line	:
City	:	NIXA
State	:	MO
Zip	:	65714-0397
Country	:	US
Telephone Number	:	417-818-3125
Fax Number	:	417-374-7582

Provider Business Practice Location Address
First Line	:	2650 W KEARNEY ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65803-2037
Country	:	US
Telephone Number	:	417-865-1547
Fax Number	:	417-862-2571

Authorized Official
Title or Position	:	OWNER
Name	:	DONALD G SAVLEY
Credential	:
Telephone Number	:	417-818-3125

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	03/05/2020

2101 E JEFFERSON ST , KAISER PERMANENTE SPRINGFIELD MEDICARE ENROLLMENT
ROCKVILLE, MD
20852-4908

Practice Phone: 701-922-1000
Practice Fax: 703-922-1039