1164452801 NPI number — HY-VEE INC

Table of content: (NPI 1164452801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164452801 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:
Provider Other Organization Name Type Code:
6
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:
1164452801
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 850442
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55485-0442
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:
1217 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARYVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64468-2603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-582-2199
Provider Business Practice Location Address Fax Number:
660-582-2456
Provider Enumeration Date:
07/04/2006

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:  745472 , 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: 745472 , 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: 624780201 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2632710 . This is a "NCPDP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 0535260 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 604780205 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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