Organization
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Active
Other names
Cooperative Health Newberry
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY M TILLEY (SR. CREDENTIALING SPECIALIST)
(804) 306-1203
Entity
Organization
Contact information
Practice address
2525 KINARD ST, NEWBERRY, SC 29108-2909
(803) 405-0220
(803) 405-0222
Mailing address
PO BOX 3788, COLUMBIA, SC 29230-3788
(803) 753-5591
(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
—
FQC131
—
SC
Enumeration date
07/13/2010
Last updated
08/14/2025
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