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General NPI Number Information
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NPI Number | 1518264043
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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 | 02/18/2011
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Last Update Date | 06/22/2011
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Provider Practice Location Address
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Address Line | 2 SUCCESS BLVD
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City | PERRY
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State | OH
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Zip | 44081-9404
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Country | US
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Telephone | 440-375-8590
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Fax | 440-259-2106
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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 | 440-354-1985
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Fax | 440-350-4938
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Authorized Official
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Title or Position | CFO
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Name | MICHAEL KITTOE
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Credential |
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Telephone | 440-354-1085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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