1972689172 NPI number — LAKE HOSPITAL SYSTEM INC

Table of content: (NPI 1972689172)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972689172 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:
1972689172
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 772930
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48277-2930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-953-9600
Provider Business Mailing Address Fax Number:
440-953-6081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36000 EUCLID AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLOUGHBY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44094-4662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-953-9600
Provider Business Practice Location Address Fax Number:
440-953-6081
Provider Enumeration Date:
10/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHRILLERO
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF FINANCIAL PLANNING
Authorized Official Telephone Number:
216-767-8141

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 273Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0140D446 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 807020000 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 816807662A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP33687 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10024977600 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP43687 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016066904 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 803272 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 909509800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0011437050002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4922507 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: D2490320 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: LAK0098N , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3600098 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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