Type 2 · Organization ✓ Active NPI ✓ Valid NPI checksum

Shopko Stores Operating Co. LLC

Durable Medical Equipment & Medical Supplies in East Peoria, IL · enumerated 2006 · authorized official Michael Bettiga, Sr. Vice President Health Services.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1972539740

Verified

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Registry record

Entity type Organization (Type 2)

Legal business name Shopko Stores Operating Co. LLC

Other name <Unavail>

Practice address 105 N Main St, East Peoria, IL, 61611

Phone (309) 699-0632

Fax (309) 694-6426

Enumeration date Jun 24, 2006

Last updated in NPPES Sep 11, 2025

Taxonomy & classification

332B00000X Durable Medical Equipment & Medical Supplies Suppliers Primary

3336C0003X Community/Retail Pharmacy Suppliers Secondary

Authorized official

Name Michael Bettiga

Title Sr. Vice President Health Services

Phone (920) 429-4297

Other identifiers

Identifier	Type	State	Issuer
1472048	Other	-	NCPDP NUMBER
410985054173	Medicaid	IL	-

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

Where is Shopko Stores Operating Co. LLC located?

The practice location on file with NPPES is in East Peoria, IL.

How current is this record?

Data comes from the CMS NPPES public dissemination file; this record was last updated in NPPES on 2025-09-11. Verify at npiregistry.cms.hhs.gov.

Providers at this address

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Shopko Stores Operating Co. LLC Eyewear Supplier · East Peoria, IL NPI 1619929015

Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2025-09-11.