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General NPI Number Information
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NPI Number | 1710207329
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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 | 06/04/2010
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Last Update Date | 06/04/2010
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Provider Practice Location Address
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Address Line | 9485 MENTOR AVE SUITE 202
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City | MENTOR
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State | OH
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Zip | 44060-4597
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Country | US
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Telephone | 440-205-5862
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Fax | 440-205-5861
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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 | 440-205-5862
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Fax | 440-205-5861
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. ROBERT B TRACZ
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Credential |
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Telephone | 440-354-1642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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