Provider Demographics
NPI:1669778676
Name:LAKE HOSPITAL SYSTEM INC.
Entity type:Organization
Organization Name:LAKE HOSPITAL SYSTEM INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:EBEL
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 1:15050 S SPRINGDALE AVE
Practice Address - Street 2:
Practice Address - City:MIDDLEFIELD
Practice Address - State:OH
Practice Address - Zip Code:44062-9211
Practice Address - Country:US
Practice Address - Phone:440-632-3024
Practice Address - Fax:440-632-3026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center