Organization
EAU CLAIRE COOPERATIVE HEALTH CENTER ,INC.
Active
Other names
Waverly Women's Health Eau Claire
Organization subpart
No
Provider details
NPI number
Authorized official
DELGADO CANTAVE (CEO)
(803) 733-5969
Entity
Organization
Contact information
Practice address
1228 HARDEN ST, STE.B, COLUMBIA, SC 29204-1800
(803) 744-0540
(803) 744-0542
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
01
—
FQC031
MEDICAID FQC NUMBER
SC
05
—
FQC134
—
SC
Enumeration date
02/07/2013
Last updated
02/03/2022
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