Eau Claire Medical Clinic, S.C.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

EAU CLAIRE MEDICAL CLINIC, S.C.

Practice address

703 W Hamilton Ave
Eau Claire, WI 54701-6938

Phone

(715) 839-9280

Fax

(715) 839-9348

NPI assigned

Nov 14, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Anton I Kidess, MD

Title

Director

Phone

(715) 839-9280

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1321228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321228800000",
    "number": "1962789362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 W HAMILTON AVE",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547016938",
            "telephone_number": "715-839-9280",
            "fax_number": "715-839-9348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 W HAMILTON AVE",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547016938",
            "telephone_number": "715-839-9280",
            "fax_number": "715-839-9348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAU CLAIRE MEDICAL CLINIC, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-14",
        "last_updated": "2011-11-14",
        "status": "A",
        "authorized_official_last_name": "KIDESS",
        "authorized_official_first_name": "ANTON",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "715-839-9280",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36203500",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00374505",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eau Claire Family Dental
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• Eau Claire Heart Institute
• Eau Claire Home Care LLC
• Eau Claire Medical Clinic, S.C.
• Eau Claire Metro Treatment Center
• Eau Claire Metro Treatment Center
• Eau Claire Periodontics, L.L.C.
• Eau Claire Psychologists LLC
• Eau Claire Refractive LLC

• Clinical Medical Laboratory in Eau Claire, WI
• Providers in Eau Claire, WI by specialty
• Clinical Medical Laboratory in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2011; 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.