# LAKE HOSPITAL SYSTEM, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lake County Family Practice
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821253048
- **Authorized official:** ROBERT B TRACZ (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (440) 354-1642

## Contact information

- **Practice address:** 9500 MENTOR AVE, SUITE 100, MENTOR, OH 44060-8713
- **Practice address phone:** (440) 352-4880
- **Practice address fax:** (440) 352-3629
- **Mailing address:** PO BOX 715165, COLUMBUS, OH 43271-0001
- **Mailing address phone:** (440) 352-4880
- **Mailing address fax:** (440) 352-3629

## Taxonomy

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

## Other

- **Enumeration date:** 07/28/2008
- **Last updated:** 07/28/2008