MEDICARE: HY-VEE INC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	876	IA
2	3336C0003X	Community/Retail Pharmacy	876	IA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	I10879	OTHER	IA	MEDICARE LAB BILLING

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1614583	OTHER	IA	NCPDP

NPI Number	:	1023047479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HY-VEE INC

Provider Business Mailing Address
First Line	:	PO BOX 850442
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55485-0442
Country	:	US
Telephone Number	:	515-267-2800
Fax Number	:	515-559-2593

Provider Business Practice Location Address
First Line	:	1990 GRAND AVE
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-4222
Country	:	US
Telephone Number	:	515-223-8506
Fax Number	:	515-223-1168

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT
Name	:	ANGIE NELSON
Credential	:
Telephone Number	:	515-267-2800

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	10/04/2023

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308