| Lakeside Primary Care | |
|
1720 Mesquite Ave Ste 100 Lake Havasu City AZ 86403-5602 | |
| (928) 505-5555 | |
| (928) 505-5557 |
| Full Name | Lakeside Primary Care |
|---|---|
| Speciality | Family Medicine |
| Location | 1720 Mesquite Ave Ste 100, Lake Havasu City, Arizona |
| Authorized Official Name and Position | Daniel Edward Heiner (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 9285055555 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Primary Care 25 Riviera Blvd Lake Havasu City AZ 86403-5694 Ph: (928) 505-5555 | Lakeside Primary Care 1720 Mesquite Ave Ste 100 Lake Havasu City AZ 86403-5602 Ph: (928) 505-5555 |
| NPI Number | 1356099790 |
|---|---|
| Provider Enumeration Date | 03/15/2022 |
| Last Update Date | 09/12/2024 |
| Medicare PECOS PAC ID | 1052316445 |
|---|---|
| Medicare Enrollment ID | O20230424002661 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356099790 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
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