Organization
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Active
Organization
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DELGADO CANTAVE (CHIEF EXECUTIVE OFFICER)
(803) 733-5969
Entity
Organization
Contact information
Practice address
1228 HARDEN ST, COLUMBIA, SC 29204-1800
(803) 733-5969
(803) 753-5591
Mailing address
PO BOX 3788, COLUMBIA, SC 29230-3788
(803) 733-5969
(803) 252-5624
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4350
PALMETTO GBA
SC
05
—
CBP018
—
SC
05
—
FQC031
—
SC
Enumeration date
07/20/2005
Last updated
02/03/2022
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