Organization
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC
Active
Other names
Cooperative Health Winnsboro
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY M TILLEY (SR. CREDENTIALING SPECIALIST)
(804) 306-1203
Entity
Organization
Contact information
Practice address
1136 KINCAID BRIDGE RD, STE. A, WINNSBORO, SC 29180-7116
(803) 635-1052
(803) 712-9724
Mailing address
PO BOX 3788, COLUMBIA, SC 29230-3788
(803) 733-5969
(803) 753-5591
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CBP018
—
SC
05
—
FQC031
—
SC
05
—
FQC133
—
SC
Enumeration date
02/24/2011
Last updated
08/14/2025
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