Organization
LAKE HOSPITAL SYSTEM, INC.
Active
Other names
Lake County Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT B TRACZ (CHIEF FINANCIAL OFFICER)
(440) 354-1642
Entity
Organization
Contact information
Practice address
9500 MENTOR AVE, SUITE 100, MENTOR, OH 44060-8713
(440) 352-4880
(440) 352-3629
Mailing address
PO BOX 715165, COLUMBUS, OH 43271-0001
(440) 352-4880
(440) 352-3629
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LA9368241
MEDICARE GROUP NUMBER
OH
Enumeration date
07/28/2008
Last updated
07/28/2008
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