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
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