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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