Organization
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Active
Other names
Brookland Cayce Medical Practice
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DELGADO CANTAVE (CEO)
(803) 733-5969
Entity
Organization
Contact information
Practice address
1115 STATE ST, CAYCE, SC 29033-4342
(803) 939-0174
(803) 217-0282
Mailing address
PO BOX 3788, COLUMBIA, SC 29230-3788
(803) 733-5969
(803) 753-5591
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
05
—
FQC144
—
SC
Enumeration date
06/24/2010
Last updated
02/03/2022
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