# EAU CLAIRE COOPERATIVE HEALTH CENTER ,INC.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Cooperative Health Teen and Young Adult Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700728052
- **Authorized official:** KIMBERLY M TILLEY (SR. CREDENTIALING SPECIALIST)
- **Authorized official phone:** (803) 530-7855

## Contact information

- **Practice address:** 4809 MONTICELLO RD, COLUMBIA, SC 29203-4124
- **Practice address phone:** (803) 888-1106
- **Practice address fax:** (803) 602-0035
- **Mailing address:** 4809 MONTICELLO RD, COLUMBIA, SC 29203-4124
- **Mailing address phone:** (803) 888-1106
- **Mailing address fax:** (803) 602-0035

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0000X | Adolescent Medicine (Family Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/07/2026
- **Last updated:** 08/11/2026