Organization
LAKE HOSPITAL SYSTEM, INC.
Active
Parent organization
LAKE HOSPITAL SYSTEM, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAKE HOSPITAL SYSTEM, INC.
Authorized official
ROBERT B TRACZ (CHIEF FINANCIAL OFFICER)
(440) 354-1642
Entity
Organization
Contact information
Practice address
7580 AUBURN ROAD, SUITE 202, CONCORD TOWNSHIP, OH 44077
(440) 352-0400
(440) 352-4535
Mailing address
PO BOX 714328, COLUMBUS, OH 43271-4328
(440) 354-1899
(440) 354-1089
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LA9368241
MEDICARE PTAN
OH
Enumeration date
10/03/2008
Last updated
03/17/2018
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