| Lake Hospital System Inc | |
|
510 Fifth Avenue Chardon OH 44024 | |
| (440) 279-1528 | |
| (440) 279-1516 |
| Full Name | Lake Hospital System Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 510 Fifth Avenue, Chardon, Ohio |
| Authorized Official Name and Position | Robert Tracz (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 4403541051 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Hospital System Inc Po Box 714328 Columbus OH 43271-4328 Ph: (800) 354-1985 | Lake Hospital System Inc 510 Fifth Avenue Chardon OH 44024 Ph: (440) 279-1528 |
| NPI Number | 1538101985 |
|---|---|
| Provider Enumeration Date | 06/11/2006 |
| Last Update Date | 09/06/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538101985 | NPI | - | NPPES |
| 2017294 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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