Healthcare Provider Details

I. General information

NPI: 1477629079
Provider Name (Legal Business Name): HILLMED SURGICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12800 SHAKER BLVD
CLEVELAND OH
44120-2033
US

IV. Provider business mailing address

12800 SHAKER BLVD
CLEVELAND OH
44120-2033
US

V. Phone/Fax

Practice location:
  • Phone: 216-619-4900
  • Fax: 216-752-3991
Mailing address:
  • Phone: 216-619-4900
  • Fax: 216-752-3991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberHMER22066
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberHMER22066
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateOH

VIII. Authorized Official

Name: ANDREA LISA MCILWAINE
Title or Position: MANAGER
Credential: RRT
Phone: 216-619-4900