# LAKE HOSPITAL SYSTEM, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PrimeHealth Perry Health and Wellness Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174762512
- **Authorized official:** ROBERT TRACZ (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (440) 354-1642

## Contact information

- **Practice address:** 2 SUCCESS BLVD., PERRY, OH 44081
- **Practice address phone:** (440) 375-8590
- **Practice address fax:** (440) 259-2106
- **Mailing address:** PO BOX 714328, COLUMBUS, OH 43271-4328
- **Mailing address phone:** (440) 375-8590
- **Mailing address fax:** (440) 259-2106

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/09/2009
- **Last updated:** 02/09/2009