# LAKE HOSPITAL SYSTEM, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lake Health Urgent Care and Walk In Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689634966
- **Authorized official:** MR. ROBERT TRACZ (CFO)
- **Authorized official phone:** (440) 354-1952

## Contact information

- **Practice address:** 510 5TH AVE, CHARDON, OH 44024-1077
- **Practice address phone:** (440) 286-8908
- **Practice address fax:** (440) 257-1527
- **Mailing address:** PO BOX 781348, DETROIT, MI 48278-4110
- **Mailing address phone:** (440) 286-8908
- **Mailing address fax:** (440) 279-1527

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/23/2006
- **Last updated:** 02/17/2017