Healthcare Provider Details

I. General information

NPI: 1982649661
Provider Name (Legal Business Name): HY-VEE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 MARTWAY ST
MISSION KS
66202-3290
US

IV. Provider business mailing address

PO BOX 850442
MINNEAPOLIS MN
55485-0442
US

V. Phone/Fax

Practice location:
  • Phone: 913-831-4477
  • Fax: 913-831-9263
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 Number209081
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8030
License Number StateKS

VII. Legacy identifiers

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

# 1
Identifier100459120A
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer
# 2
Identifier100433490A
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer
# 3
Identifier1714888
Identifier TypeOTHER
Identifier StateKS
Identifier IssuerNCPDP

VIII. Authorized Official

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