Organization
LAKE HOSPITAL SYSTEM INC
Active
Other names
Prime Health Perry Health and Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL KITTOE (CFO)
(440) 354-1085
Entity
Organization
Contact information
Practice address
2 SUCCESS BLVD, PERRY, OH 44081-9404
(440) 375-8590
(440) 259-2106
Mailing address
PO BOX 714328, COLUMBUS, OH 43271-4328
(440) 354-1985
(440) 350-4938
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2925964
—
OH
Enumeration date
02/18/2011
Last updated
06/22/2011
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