MEDICARE: HY-VEE INC

Medicare Provider Information

Scope of Practice

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	2005009613	MO
2	3336C0003X	Community/Retail Pharmacy	2005009613	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2635994	OTHER	MO	NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043248115
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	:	929 HIGHWAY D
Second Line	:
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3169
Country	:	US
Telephone Number	:	573-302-8383
Fax Number	:	573-302-8484

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	11/17/2023

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