# LAKESIDE ORTHOPEDIC INSTITUTE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lakeside MRI
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912524380
- **Authorized official:** DANIEL EDWARD HEINER MD (PARTNER)
- **Authorized official phone:** (928) 505-5555

## Contact information

- **Practice address:** 25 RIVIERA BLVD, LAKE HAVASU CITY, AZ 86403-5694
- **Practice address phone:** (928) 505-5555
- **Practice address fax:** (928) 505-2877
- **Mailing address:** 25 RIVIERA BLVD, LAKE HAVASU CITY, AZ 86403-5694
- **Mailing address phone:** (928) 505-5555
- **Mailing address fax:** (928) 505-2877

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1200X | Magnetic Resonance Imaging (MRI) Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/01/2020
- **Last updated:** 01/29/2025