Organization
EAU CLAIRE COOPERATIVE HEALTH CENTER ,INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY M TILLEY (CREDENTIALING MANAGER)
(804) 306-1203
Entity
Organization
Contact information
Practice address
4809 MONTICELLO RD, COLUMBIA, SC 29203-4124
(803) 888-1106
(803) 602-0035
Mailing address
4809 MONTICELLO RD, COLUMBIA, SC 29203-4124
(803) 888-1106
(803) 602-0035
Taxonomy
Speciality
Code
Description
License number
State
207QA0000X
Adolescent Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
04/07/2026
Last updated
04/07/2026
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