Organization
LAKE HOSPITAL SYSTEM, INC
Active
Other names
Lake Health Walk In Center
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT TRACZ (CFO)
(440) 354-1952
Entity
Organization
Contact information
Practice address
74 S PARK PLACE, PAINESVILLE, OH 44077
(440) 354-3887
(440) 354-4071
Mailing address
PO BOX 781348, DETROIT, MI 48278-1348
(440) 354-3887
(440) 354-4071
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2017301
—
OH
Enumeration date
10/15/2009
Last updated
02/17/2017
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