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Organization
EAU CLAIRE COOPERATIVE HEALTH CENTER ,INC.
Active
Organization
EAU CLAIRE COOPERATIVE HEALTH CENTER ,INC.
Active
Other names
Cooperative Health Teen and Young Adult Center
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY M TILLEY (SR. CREDENTIALING SPECIALIST)
(803) 530-7855
Entity
Organization
Contact information
Practice address
4809 MONTICELLO RD, COLUMBIA, SC 29203-4124
(803) 888-1106
(803) 602-0035
Mailing address
4809 MONTICELLO RD, COLUMBIA, SC 29203-4124
(803) 888-1106
(803) 602-0035
Taxonomy
Speciality
Code
Description
License number
State
207QA0000X
Adolescent Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
04/07/2026
Last updated
08/11/2026
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