MEDICARE: MEDISERV SHORT NORTH PHCY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0002X	Clinic Pharmacy
2	3336C0003X	Community/Retail Pharmacy		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3673779	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1659459162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDISERV SHORT NORTH PHCY INC

Provider Business Mailing Address
First Line	:	21 W HUBBARD AVE
Second Line	:	STE B
City	:	COLUMBUS
State	:	OH
Zip	:	43215-1474
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 W HUBBARD AVE
Second Line	:	STE B
City	:	COLUMBUS
State	:	OH
Zip	:	43215-1474
Country	:	US
Telephone Number	:	614-294-6231
Fax Number	:	614-294-6223

Authorized Official
Title or Position	:	THIRD PARTY ADMIN
Name	:	TRACY HAMMOND
Credential	:
Telephone Number	:	614-481-4272

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	09/11/2025

Similar Medicare Providers

1821197229 — DR. HETAL V VAIDYA D.D.S
Practice Location Address:

21 W HUBBARD AVE
COLUMBUS, OH
43215-1474

Practice Phone: 614-258-3880
Practice Fax: 614-252-5873

1205960697 — MS. MARY EILEEN GRITTON
Practice Location Address:

413 WALHALLA RD
COLUMBUS, OH
43202-1474

Practice Phone: 614-506-5151
Practice Fax:

1902110943 — PRUDENCIA NCHONGANYI NKONDEM LPN
Practice Location Address:

4349 WALFORD ST , APT. B1
COLUMBUS, OH
43224-1474

Practice Phone: 614-516-3361
Practice Fax:

1043566375 — ASHLEY JUDSON RD
Practice Location Address:

1653 GLOBE ST
COLUMBUS, OH
43212-1474

Practice Phone: 440-452-9294
Practice Fax:

1467276105 — KRASWGN WOODS
Practice Location Address:

1474 SIMPSON DR
COLUMBUS, OH
43227-1364

Practice Phone: 614-735-4087
Practice Fax:

1861297970 — EDEN ZEWDU WOLDE
Practice Location Address:

1288 SHADY LANE RD
COLUMBUS, OH
43227-1474

Practice Phone: 614-813-6819
Practice Fax:

Directions to “MEDISERV SHORT NORTH PHCY INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.