Organization
LAKE HOSPITAL SYSTEM, INC
Active
Other names
Lake Health Urgent Care and Walk In Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT TRACZ (CFO)
(440) 354-1952
Entity
Organization
Contact information
Practice address
7956 TYLER BLVD, MENTOR, OH 44060-4806
(440) 255-6400
(440) 255-3637
Mailing address
PO BOX 781348, DETROIT, MI 48278-1348
(800) 354-1985
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2017301
—
OH
05
—
2440175
—
OH
01
—
264200000
FEDERAL BLACK LUNG
OH
01
—
6600162
UNITED HEALTHCARE
OH
Enumeration date
03/23/2006
Last updated
02/15/2017
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