# LAKE HOSPITAL SYSTEM

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LAKE HOSPITAL SYSTEM
- **Other names:** PrimeHealth Willowick Primary Care
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1326141987
- **Legal business name:** LAKE HOSPITAL SYSTEM
- **Authorized official:** MR. ROBERT TRACZ (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (440) 354-1051

## Contact information

- **Practice address:** 29804 LAKESHORE BLVD, WILLOWICK, OH 44095
- **Practice address phone:** (440) 833-2095
- **Practice address fax:** (440) 833-2096
- **Mailing address:** PO BOX 714328, COLUMBUS, OH 43271-4328
- **Mailing address phone:** (800) 354-1985
- **Mailing address fax:** (440) 350-4938

## Taxonomy

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