Organization
PAMIDA STORES OPERATING CO. LLC
Active
Organization
PAMIDA STORES OPERATING CO. LLC
Active
Other names
Pamida Home Medical Equipment 177
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL E ROTHAMEL (CEO/PRESIDENT)
(402) 596-7499
Entity
Organization
Contact information
Practice address
8 S MAIN ST, CLINTONVILLE, WI 54929-1565
(715) 823-2106
(715) 823-1322
Mailing address
8 S MAIN ST, CLINTONVILLE, WI 54929-1565
(715) 823-2106
(715) 823-1322
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41738400
—
WI
01
—
5105475
NCPDP NUMBER
—
01
—
5694490114
MEDICARE
—
Enumeration date
06/01/2006
Last updated
04/14/2008
Update your record
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