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Organization
LAKE HOSPITAL SYSTEM
Active
Organization
LAKE HOSPITAL SYSTEM
Active
Parent organization
LAKE HOSPITAL SYSTEM
Other names
PrimeHealth Willowick Primary Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAKE HOSPITAL SYSTEM
Authorized official
MR. ROBERT TRACZ (CHIEF FINANCIAL OFFICER)
(440) 354-1051
Entity
Organization
Contact information
Practice address
29804 LAKESHORE BLVD, WILLOWICK, OH 44095
(440) 833-2095
(440) 833-2096
Mailing address
PO BOX 714328, COLUMBUS, OH 43271-4328
(800) 354-1985
(440) 350-4938
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
35-084193
OH
208000000X
Pediatrics Physician
35-084193
NULL
208000000X
Pediatrics Physician
35-084193
—
Other
Enumeration date
09/07/2006
Last updated
04/08/2008
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