1134286875 NPI number — HY-VEE INC

Table of content: (NPI 1134286875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134286875 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 CLINIC PHARMACY (1871)
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:
1134286875
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 61
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEROKEE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51012-0061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-225-1903
Provider Business Mailing Address Fax Number:
712-225-5700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 5TH ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERTOWN
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57201-4940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-886-4207
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EGELAND
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
VICE PRESIDENT, PHARMACY
Authorized Official Telephone Number:
515-453-2784

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  100-1921 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 1001921 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8504410 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: S40975 . This is a "MEDICARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4353986 . This is a "NCPDP" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




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