Organization
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Active
Other names
Eastover Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
DELGADO CANTAVE (CEO)
(803) 733-5969
Entity
Organization
Contact information
Practice address
3041 OLD EASTOVER ROAD, EASTOVER, SC 29044-2417
(803) 353-8741
(803) 353-8789
Mailing address
PO BOX 3788, COLUMBIA, SC 29230-3788
(803) 733-5969
(803) 252-5624
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CBP018
—
SC
05
—
FQC031
—
SC
05
—
FQC132
—
SC
Enumeration date
02/24/2011
Last updated
02/10/2022
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