Organization
LAKE HOSPITAL SYSTEM, INC.
Active
Parent organization
LAKE HOSPITAL SYSTEM, INC.
Other names
PrimeHealth Internal Medicine Mentor
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
9485 MENTOR AVE, #210, MENTOR, OH 44060-4597
(440) 205-5745
(440) 205-5735
Mailing address
PO BOX 714328, COLUMBUS, OH 43271-4328
(800) 354-1985
(440) 350-4938
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2183499
—
OH
Enumeration date
06/29/2006
Last updated
09/06/2007
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