Active NPI
Roundys Supermarkets Inc
- Community/Retail Pharmacy
- Stevens Point, WI
National Provider Identifier
1710214713
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 8983-42
- Legal business name
- ROUNDYS SUPERMARKETS INC
- Practice address
- 3256 Church St
Stevens Point, WI 54481-5321 - Phone
- (715) 344-6910
- Fax
- (715) 344-2781
- NPI assigned
- Nov 11, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Edward Kitz
- Title
- GVP - Legal Risk & Treasury
- Phone
- (414) 231-5000
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 8983-42 | WI | Primary |
Addresses
Primary practice location
3256 Church St
Stevens Point, WI 54481-5321
Mailing address
PO Box 473
Ms-2870
Milwaukee, WI 53201-0473
Phone (414) 231-6153
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710214713 | Medicaid | WI | |
| 5131999 | Other | NCPDP PROVIDER IDENTIFICATION NUMBER |
Other names 1
- COPPS FOOD CENTER PHARMACY
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080218000141 | WI | Part B Supplier - Mass Immunization (Roster Biller Only) | 5698858470 | This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider DirectoryMember of 3
Organizations this organization is a member of, according to the National Provider Directory.
Locations
3256 Church St
Stevens Point, WI 54481
Phone (715) 344-6910
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1257897600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1302134400000",
"number": "1710214713",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 473",
"address_2": "MS-2870",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532010473",
"telephone_number": "414-231-6153",
"fax_number": "414-231-5500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3256 CHURCH ST",
"city": "STEVENS POINT",
"state": "WI",
"postal_code": "544815321",
"telephone_number": "715-344-6910",
"fax_number": "715-344-2781"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ROUNDYS SUPERMARKETS INC",
"organizational_subpart": "NO",
"enumeration_date": "2009-11-11",
"last_updated": "2011-04-07",
"status": "A",
"authorized_official_last_name": "KITZ",
"authorized_official_first_name": "EDWARD",
"authorized_official_title_or_position": "GVP - LEGAL RISK & TREASURY",
"authorized_official_telephone_number": "414-231-5000"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "WI",
"license": "8983-42",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1710214713",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
"identifier": "5131999",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "COPPS FOOD CENTER PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Stevens Point, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.