| Organization Name: | LAKE HOSPITAL SYSTEM INC. |
| NPI Number: | 1043275837 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT TRACZ (CFO) |
| Mailing Address: | 7590 Auburn Rd Concord Twp |
| State: | OH US |
| Postal Code: | 440779176 |
| Phone Number: | 4403541952 |
| Fax Number: | 4403504503 |
| NPI Enumeration Date: | 04/18/2006 |
| NPI Last Update Date: | 09/10/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |