Organization
LAKESIDE ORTHOPEDIC INSTITUTE LLC
Active
Other names
Lakeside Mobile Imaging
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL EDWARD HEINER (AUTHORIZED OFFICIAL)
(928) 505-5555
Entity
Organization
Contact information
Practice address
25 RIVIERA BLVD, LAKE HAVASU CITY, AZ 86403-5694
(928) 505-5555
Mailing address
25 RIVIERA BLVD, LAKE HAVASU CITY, AZ 86403-5694
(928) 505-5555
Taxonomy
Speciality
Code
Description
License number
State
261QR0208X
Mobile Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
08/23/2021
Last updated
04/22/2026
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