Organization
EAU CLAIRE COOPERTIVE HEALTH CENTER, INC.
Active
Other names
Women's Health & Internal Medicine of Batesburg-Leesville
Organization subpart
No
Provider details
NPI number
Authorized official
DELGADO CANTAVE (CEO)
(803) 733-5969
Entity
Organization
Contact information
Practice address
338 E COLUMBIA AVE, SUITE B, LEESVILLE, SC 29070-9285
(803) 532-1580
(803) 532-3832
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
01
—
4350
MEDICARE PART B
SC
05
—
CBP018
—
SC
05
—
FQC031
—
SC
05
—
FQC123
—
SC
Enumeration date
06/17/2010
Last updated
10/10/2022
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