MEDICARE: NIEMANN FOODS INC

Medicare Provider Information

Scope of Practice

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	3336C0003X	Community/Retail Pharmacy	054016034	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1479989	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1558473496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIEMANN FOODS INC

Provider Business Mailing Address
First Line	:	PO BOX C847
Second Line	:
City	:	QUINCY
State	:	IL
Zip	:	62306-0847
Country	:	US
Telephone Number	:	217-221-5649
Fax Number	:	217-221-5915

Provider Business Practice Location Address
First Line	:	2777 S 6TH ST
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62703-4071
Country	:	US
Telephone Number	:	217-744-2296
Fax Number	:	217-744-9826

Authorized Official
Title or Position	:	CFO
Name	:	CHRISTOPHER NIEMANN
Credential	:
Telephone Number	:	217-221-5612

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	09/27/2021

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