# LAKES REGION ARTIFICIAL LIMB AND BRACE COMPANY INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285695783
- **Authorized official:** MR. KENNETH MARVIN HEIDE CPO (PRESIDENT)
- **Authorized official phone:** (218) 486-1963

## Contact information

- **Practice address:** 710 VALLEY ST, HAWLEY, MN 56549
- **Practice address phone:** (218) 486-1963
- **Mailing address:** 710 VALLEY ST, HAWLEY, MN 56549
- **Mailing address phone:** (218) 486-1963

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 335E00000X | Prosthetic/Orthotic Supplier | — | NULL | Yes |

## Other

- **Enumeration date:** 04/01/2006
- **Last updated:** 10/30/2007