=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588419881
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HY-VEE HEALTH PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2024
-----------------------------------------------------
Last Update Date | 04/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3000 S MINNESOTA AVE
-----------------------------------------------------
City | SIOUX FALLS
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57105-5647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-225-2930
-----------------------------------------------------
Fax | 515-559-2495
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5820 WESTOWN PKWY
-----------------------------------------------------
City | WEST DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50266-8223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CMO
-----------------------------------------------------
Name | DANIEL S FICK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 515-221-4663
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------