1316277874 NPI number — HY-VEE INC

Table of content: (NPI 1316277874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316277874 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:
1316277874
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:
712-225-5706
Provider Business Mailing Address Fax Number:
712-225-5700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3505 L ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68107-2565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-731-9971
Provider Business Practice Location Address Fax Number:
402-731-8367
Provider Enumeration Date:
01/06/2010

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  2004 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 2004 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10025830700 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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