Mediserv Cleveland Phcy Inc

Primary specialty

Clinic PharmacyTaxonomy code 3336C0002X

Legal business name

MEDISERV CLEVELAND PHCY INC

Practice address

1570 Cleveland Ave
Columbus, OH 43211-2755

Phone

(614) 294-2642

Fax

(614) 294-2645

NPI assigned

Nov 1, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tracy Hammond

Title

Third Party Admin

Phone

(614) 481-4272

Specialties & licenses 2

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1295813707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1570 CLEVELAND AVE",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432112755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1570 CLEVELAND AVE",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432112755",
            "telephone_number": "614-294-2642",
            "fax_number": "614-294-2645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDISERV CLEVELAND PHCY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "HAMMOND",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "THIRD PARTY ADMIN",
        "authorized_official_telephone_number": "614-481-4272"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OH",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0999291",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3660330",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.