Hy-Vee Inc
Organization Active NPI Community/Retail Pharmacy · Fort Madison, IA
NPI 1912933565 · NPPES record last updated Sep 22, 2023
Key facts
- NPI
- 1912933565
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 1113 (IA)
- Legal business name
- HY-VEE INC
- Practice address
- 2606 Avenue L
Fort Madison, IA 52627-3839 - Phone
- (319) 372-9396
- Fax
- (319) 372-9610
- NPI assigned
- Jun 24, 2006
- Organization subpart
- No
Authorized official
- Name
- Angie Nelson
- Title
- Senior Vice President
- Phone
- (515) 267-2800
Corporate family (same tax ID) 24
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 16D1077850 | Hy-Vee Pharmacy #1202 | Certificate of waiver | Dec 19, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Hy Vee Pharmacy (1202) |
Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Ostomy Supplies|Urological Supplies|Nebulizer Equipment and/o… | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031230000598 | IA | Part B Supplier - Mass Immunization (Roster Biller Only) | 7416855242 |
This NPI is an additional NPI on the enrollment Practice locations: Albia, IA |
| O20100930063153 | IA | DME Supplier - Pharmacy |
7416855242 | Practice locations: Fort Madison, IA |
National Provider Directory
- Tax ID family
- Drug Town 7060
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 1113 | IA | |
| Community/Retail Pharmacy | 3336C0003X | 1113 | IA | Yes |
Addresses
Primary practice location
2606 Avenue L
Fort Madison, IA 52627-3839
Mailing address
PO Box 850442
Minneapolis, MN 55485-0442
Phone (515) 267-2800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 202655 | Medicaid | IA | |
| 1620384 | Other | IA | NCPDP |
| 605285006 | Medicaid | MO |
Other names
- Hy-Vee Pharmacy (1202)
Other providers in Fort Madison, IA
- Sara D Herr
- Charles William Holmes
- Susan J Holtkamp
- Michelle Lynn Hornung
- Michelle L Houghton
- Iarc F, LLC
- International Eyecare Center, Inc
- James G Kannenberg
- Lindsay Nicole Kelly
- Kensington Fort Madison, LLC
All providers in Fort Madison, IA · Community/Retail Pharmacy in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 22, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.