1578590006 NPI number — HY-VEE INC

Table of content: (NPI 1578590006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578590006 NPI number — HY-VEE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HY-VEE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HY-VEE PHARMACY (1384)
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578590006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 NORTH BLUE JAY DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIBERTY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64068-1906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-792-4632
Provider Business Practice Location Address Fax Number:
816-792-1429
Provider Enumeration Date:
06/28/2006

Additional Information

			
		

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  5780 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 5780 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 607860509 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2629535 . This is a "NCPDP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".