# LAKE HOSPITAL SYSTEM

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LHPG Thomas Mentor Family Practice
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942580394
- **Authorized official:** RICK CICERO (SR. VP BUSINESS DEVELOPMENT)
- **Authorized official phone:** (440) 354-1739

## Contact information

- **Practice address:** 8316 YELLOWBRICK RD, MENTOR, OH 44060-4960
- **Practice address phone:** (440) 205-8818
- **Practice address fax:** (440) 974-1794
- **Mailing address:** PO BOX 714328, COLUMBUS, OH 43271-4328
- **Mailing address phone:** (440) 205-8818
- **Mailing address fax:** (440) 974-1794

## Taxonomy

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

## Other

- **Enumeration date:** 08/17/2011
- **Last updated:** 08/17/2011