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General NPI Number Information
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NPI Number | 1265765317
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Entity Type | Organization
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Legal Business Name | LAKE HOSPITAL SYSTEM, INC.
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Dates
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Enumeration Date | 09/08/2009
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 1223 MENTOR AVE
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City | PAINESVILLE
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State | OH
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Zip | 44077-1833
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Country | US
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Telephone | 440-352-1818
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Fax | 440-352-1895
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Provider Business Mailing Address
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Address Line | PO BOX 714328
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City | COLUMBUS
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State | OH
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Zip | 43271-4328
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Country | US
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Telephone | 440-352-1818
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Fax | 440-352-1895
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Authorized Official
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Title or Position | SR. VP, BUSINESS DEVELOPMENT
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Name | RICHARD CICERO
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Credential |
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Telephone | 440-354-1739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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