Organization
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Active
Organization
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Active
Other names
Eau Claire Developmental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY TILLEY (CREDENTIALING MANAGER)
(804) 306-1203
Entity
Organization
Contact information
Practice address
4601 MONTICELLO ROAD, COLUMBIA, SC 29203
(803) 356-7102
(803) 356-7106
Mailing address
PO BOX 3788, COLUMBIA, SC 29230-3788
(803) 733-5969
(803) 753-5591
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CBP018
—
SC
05
—
FQC031
—
SC
05
—
FQC181
—
SC
Enumeration date
01/15/2015
Last updated
06/24/2026
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