Organization
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Active
Other names
Ridgeway Pediatrics, Family & Dental Practice
Organization subpart
No
Provider details
NPI number
Authorized official
DELGADO CANTAVE (CEO)
(803) 733-5969
Entity
Organization
Contact information
Practice address
755 US HIGHWAY 21 S, RIDGEWAY, SC 29130-6844
(803) 337-2920
(803) 337-3010
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
05
—
CBP018
—
SC
05
—
FQC031
—
SC
05
—
FQC176
—
SC
Enumeration date
06/18/2010
Last updated
03/19/2021
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