Organization
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Active
Organization
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Active
Other names
Laurel Medical Practice
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STUART A. HAMILTON M.D. (CEO)
(803) 733-5969
Entity
Organization
Contact information
Practice address
1520 LAUREL ST, COLUMBIA, SC 29201-2623
(803) 799-8407
(803) 799-8148
Mailing address
PO BOX 3788, COLUMBIA, SC 29230-3788
(803) 733-5969
(803) 252-5624
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
Enumeration date
03/23/2006
Last updated
02/03/2022
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