Healthcare Provider Details

I. General information

NPI: 1770307613
Provider Name (Legal Business Name): HY VEE HEALTH OF KANSAS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3504 CLINTON PKWY
LAWRENCE KS
66047-2145
US

IV. Provider business mailing address

5820 WESTOWN PKWY
WEST DES MOINES IA
50266-8223
US

V. Phone/Fax

Practice location:
  • Phone: 515-695-3121
  • Fax:
Mailing address:
  • Phone: 515-225-2930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: DANIEL S FICK
Title or Position: OWNER
Credential: MD
Phone: 515-225-2930