Provider Demographics
NPI:1922390012
Name:LAKE HOSPITAL SYSTEM INC
Entity Type:Organization
Organization Name:LAKE HOSPITAL SYSTEM INC
Other - Org Name:PRIME HEALTH
Other - Org Type:Other Name
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:440-354-1985
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:440-354-1985
Mailing Address - Fax:440-350-4938
Practice Address - Street 1:6067 N RIDGE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-2441
Practice Address - Country:US
Practice Address - Phone:440-417-0002
Practice Address - Fax:440-417-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-06
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center