# LAKESIDE ORTHOPEDIC INSTITUTE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LAKESIDE ORTHOPEDIC INSTITUTE, LLC
- **Other names:** Lakeside Primary Care
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1356099790
- **Legal business name:** LAKESIDE ORTHOPEDIC INSTITUTE, LLC
- **Authorized official:** DANIEL EDWARD HEINER (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (928) 505-5555

## Contact information

- **Practice address:** 1720 MESQUITE AVE STE 100, LAKE HAVASU CITY, AZ 86403-5602
- **Practice address phone:** (928) 505-5555
- **Practice address fax:** (928) 505-5557
- **Mailing address:** 25 RIVIERA BLVD, LAKE HAVASU CITY, AZ 86403-5694
- **Mailing address phone:** (928) 505-5555
- **Mailing address fax:** (928) 505-5557

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 03/15/2022
- **Last updated:** 04/22/2026