Organization
LAKE HOSPITAL SYSTEM INC
Active
Parent organization
LAKE HOSPITAL SYSTEM, INC.
Other names
PrimeHealth Pediatrics Willoughby
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAKE HOSPITAL SYSTEM, INC.
Authorized official
MR. ROBERT TRACZ (CHIEF FINANCIAL OFFICER)
(440) 354-1051
Entity
Organization
Contact information
Practice address
36001 EUCLID AVE, STE B-16, WILLOUGHBY, OH 44094
(440) 942-4844
(440) 918-4627
Mailing address
PO BOX 714328, COLUMBUS, OH 43271-4328
(800) 354-1985
(440) 350-4938
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2017338
—
OH
Enumeration date
06/11/2006
Last updated
09/06/2007
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