Organization
EAU CLAIRE COOPERATIVE HEALTH CENTER INC.
Active
Organization
EAU CLAIRE COOPERATIVE HEALTH CENTER INC.
Active
Other names
Little Mountain Pediatrics and Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
DELGADO CANTAVE (CEO)
(803) 733-5969
Entity
Organization
Contact information
Practice address
99 N MILL ST, LITTLE MOUNTAIN, SC 29075-8788
(803) 945-1005
Mailing address
PO BOX 3788, COLUMBIA, SC 29230-3788
(803) 733-5969
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
08/19/2019
Last updated
09/01/2020
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