Provider Demographics
NPI:1346202512
Name:LAKE HOSPITAL SYSTEM
Entity Type:Organization
Organization Name:LAKE HOSPITAL SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KITTOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-354-1952
Mailing Address - Street 1:PO BOX 714110
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-4110
Mailing Address - Country:US
Mailing Address - Phone:440-274-5035
Mailing Address - Fax:440-716-8608
Practice Address - Street 1:36000 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4625
Practice Address - Country:US
Practice Address - Phone:440-354-1618
Practice Address - Fax:440-354-1848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Multi-Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5000142OtherUNITED HEALTHCARE
OH18300OtherQUALCHOICE
OH5000142OtherUNITED HEALTHCARE
OH5000142OtherUNITED HEALTHCARE