Lipid Specialists, S.C.

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

54685-20 Issued in WI

Legal business name

LIPID SPECIALISTS, S.C.

Practice address

1400 75TH St
Suite 5
Kenosha, WI 53143-1544

Phone

(262) 656-1911

Fax

(262) 656-1911

NPI assigned

Oct 26, 2010

Last updated

Oct 26, 2010By 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

Mary P Eldridge, M.D.NPI 1063673903

Title

President

Phone

(262) 656-1911

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mary Patricia Eldridge, M.D.

  • General Practice Physician
  • Kenosha, WI
  • NPI 1063673903
  NPD (past) Authorized official

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

{
    "created_epoch": "1288051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288051200000",
    "number": "1710287628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 75TH ST",
            "address_2": "SUITE 5",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531431544",
            "telephone_number": "262-656-1911",
            "fax_number": "262-656-1911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 75TH ST",
            "address_2": "SUITE 5",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531431544",
            "telephone_number": "262-656-1911",
            "fax_number": "262-656-1911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIPID SPECIALISTS, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-26",
        "last_updated": "2010-10-26",
        "status": "A",
        "authorized_official_last_name": "ELDRIDGE",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-656-1911",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "WI",
            "license": "54685-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Peter Limbach, DOCTOR OF CHIROPRACT
• John M Lindell, DDS
• Kelly Lindenbaum
• Kristin Lindstrom
• Florisa Lingad
• Carrie A Liu, CSAC
• Terry C. Liu, M.D.
• Livingwell Home Medical Supplies Inc
• Livingwell N-Home Therapy LLC
• Livito LLC

• Medical Specialty Clinic/Center in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Medical Specialty Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2010; 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.