Healthcare Provider Details

I. General information

NPI: 1467500439
Provider Name (Legal Business Name): HY-VEE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 WILSON AVE SW
CEDAR RAPIDS IA
52404-5684
US

IV. Provider business mailing address

PO BOX 850442
MINNEAPOLIS MN
55485-5684
US

V. Phone/Fax

Practice location:
  • Phone: 319-362-3649
  • Fax: 319-363-1455
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1312
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1312
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0748699
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 2
Identifier1622958
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerNCPDP

VIII. Authorized Official

Name: ANGIE NELSON
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 515-267-2800