1568514636 NPI number — LAKE HOSPITAL SYSTEM, INC.

Table of content: (NPI 1568514636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568514636 NPI number — LAKE HOSPITAL SYSTEM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKE HOSPITAL SYSTEM, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568514636
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7590 AUBURN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONCORD TWP
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44077-9176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-375-8700
Provider Business Mailing Address Fax Number:
440-354-1994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9485 MENTOR AVE
Provider Second Line Business Practice Location Address:
SUITE A04
Provider Business Practice Location Address City Name:
MENTOR
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44060-4597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-639-0900
Provider Business Practice Location Address Fax Number:
440-357-4583
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KITTOE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
VP FINANCE, CFO
Authorized Official Telephone Number:
440-354-1051

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0665221 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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