Healthcare Provider Details

I. General information

NPI: 1881620912
Provider Name (Legal Business Name): HY-VEE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 12TH AVE SW
LE MARS IA
51031-3018
US

IV. Provider business mailing address

PO BOX 850442
MINNEAPOLIS MN
55485-0442
US

V. Phone/Fax

Practice location:
  • Phone: 712-548-4503
  • Fax: 712-546-4463
Mailing address:
  • Phone: 515-267-2800
  • Fax: 515-559-2593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1238
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1238
License Number StateIA

VII. Legacy identifiers

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

# 1
Identifier0426528
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 2
Identifier10025949400
Identifier TypeMEDICAID
Identifier StateNE
Identifier Issuer
# 3
Identifier16-21879
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerNCPDP

VIII. Authorized Official

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