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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