Life Skills Support Center of Eau Claire, LTD.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

LIFE SKILLS SUPPORT CENTER OF EAU CLAIRE, LTD.

Practice address

4907 Keystone Xing
Eau Claire, WI 54701-5144

Phone

(505) 730-2947

NPI assigned

Jun 29, 2007

Last updated

Jul 18, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Nino A Vidic, MD

Title

Owner

Phone

(505) 730-2947

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184716800000",
    "number": "1124225503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4907 KEYSTONE XING",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547015144",
            "telephone_number": "715-514-0340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4907 KEYSTONE XING",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547015144",
            "telephone_number": "505-730-2947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE SKILLS SUPPORT CENTER OF EAU CLAIRE, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-29",
        "last_updated": "2007-07-18",
        "status": "A",
        "authorized_official_last_name": "VIDIC",
        "authorized_official_first_name": "NINO",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-730-2947",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "50281-020",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Elizabeth Lewis, LCSW
• Thomas Lewis
• Ellen Tsyjyu Liang, M.D.
• Brooke Angela Lieffring, RDH
• Melanie Lieffring
• Lifenet, LLC
• Lifetime Dental Care SC
• Lifetime Family Dental Care LLC
• Nichole Lightbody
• Agusta Lillis, OTR

• Psychiatry Physician in Eau Claire, WI
• Providers in Eau Claire, WI by specialty
• Psychiatry Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.