Organization
LAKE HOSPITAL SYSTEM, INC.
Active
Other names
PrimeHealth Pediatrics Chardon
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT B. TRACZ (CHIEF FINANCIAL OFFICER)
(440) 354-1642
Entity
Organization
Contact information
Practice address
510 FIFTH AVENUE, CHARDON, OH 44024
(440) 279-1526
(440) 279-1527
Mailing address
P.O. BOX 714328, COLUMBUS, OH 43271-4328
(440) 354-1899
(440) 354-1089
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
12/19/2007
Last updated
12/19/2007
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