Organization
LAKES REGION ARTIFICIAL LIMB AND BRACE COMPANY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH MARVIN HEIDE CPO (PRESIDENT)
(218) 486-1963
Entity
Organization
Contact information
Practice address
710 VALLEY ST, HAWLEY, MN 56549
(218) 486-1963
Mailing address
710 VALLEY ST, HAWLEY, MN 56549
(218) 486-1963
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
109L7RE
BLUE CROSS BLUE SHIELD MN
MN
01
—
110L7RE
BLUE CROSS BLUE SHIELD MN
MN
01
—
164106
UCARE
—
01
—
23145
BLUE CROSS ND
—
05
—
54461
—
ND
01
—
8200663
MEDICA
—
01
—
8200664
MEDICA
—
05
—
9150650
—
SD
01
—
9216690
DAKOTA CARE
SD
Enumeration date
04/01/2006
Last updated
10/30/2007
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