Healthcare Provider Details

I. General information

NPI: 1356815922
Provider Name (Legal Business Name): HNI MEDICAL SERVICES OF OHIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18697 BAGLEY RD
MIDDLEBURG HEIGHTS OH
44130-3417
US

IV. Provider business mailing address

30575 BAINBRIDGE RD STE 200
CLEVELAND OH
44139-2275
US

V. Phone/Fax

Practice location:
  • Phone: 440-542-5000
  • Fax:
Mailing address:
  • Phone: 440-542-5000
  • Fax: 440-542-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHAD PEW
Title or Position: VP OF OPERATIONS
Credential:
Phone: 512-730-3060