Provider Demographics
NPI:1447203989
Name:LAKEWOOD HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:LAKEWOOD HOSPITAL ASSOCIATION
Other - Org Name:LAKEWOOD HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-444-9361
Mailing Address - Street 1:6801 BRECKSVILLE RD
Mailing Address - Street 2:SUITE 20 RK10
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-5032
Mailing Address - Country:US
Mailing Address - Phone:216-636-8051
Mailing Address - Fax:216-636-8088
Practice Address - Street 1:14519 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4316
Practice Address - Country:US
Practice Address - Phone:216-521-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1134282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH100748OtherKAISER
OH521890OtherAETNA
5000096OtherUNITED HEALTHCARE
OH4923882Medicaid
0000000157342OtherANTHEM
OH=========024OtherMEDICAL MUTUAL OF OHIO
OH360212Medicare ID - Type UnspecifiedMEDICARE