Provider Demographics
NPI:1578884797
Name:LAKE HOSPITAL SYSTEM, INC.
Entity Type:Organization
Organization Name:LAKE HOSPITAL SYSTEM, INC.
Other - Org Name:LAKE HEALTH PHYSICIAN GROUP CONCORD ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:TRACZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-354-1642
Mailing Address - Street 1:PO BOX 714328
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-4328
Mailing Address - Country:US
Mailing Address - Phone:440-602-6670
Mailing Address - Fax:440-602-6671
Practice Address - Street 1:7580 AUBURN RD
Practice Address - Street 2:SUITE 214
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-9615
Practice Address - Country:US
Practice Address - Phone:440-602-6670
Practice Address - Fax:440-602-6671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty