Provider Demographics
NPI:1801044581
Name:HY VEE IOWA HEALTH LC
Entity Type:Organization
Organization Name:HY VEE IOWA HEALTH LC
Other - Org Name:IOWA HEALTH EXPRESS CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIR OF THE BOARD OF MANAGERS
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:JURGENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-267-2880
Mailing Address - Street 1:410 N ANKENY BLVD
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-1753
Mailing Address - Country:US
Mailing Address - Phone:515-964-1601
Mailing Address - Fax:
Practice Address - Street 1:410 N ANKENY BLVD
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-1753
Practice Address - Country:US
Practice Address - Phone:515-964-1601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty