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	208556	KS
2	3336C0003X	Community/Retail Pharmacy	8361	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1715676	OTHER	KS	NCPDP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902841687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HY-VEE INC

Provider Business Mailing Address
First Line	:	PO BOX 310442
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50331-0442
Country	:	US
Telephone Number	:	515-267-2800
Fax Number	:	515-559-2593

Provider Business Practice Location Address
First Line	:	3504 CLINTON PKWY
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66047-2145
Country	:	US
Telephone Number	:	785-832-0110
Fax Number	:	785-832-0516

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

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	08/29/2023

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Directions to “HY-VEE INC ” Practice Location

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