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General NPI Number Information
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NPI Number | 1093051245
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Entity Type | Organization
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Legal Business Name | EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
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Dates
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Enumeration Date | 12/17/2012
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Last Update Date | 02/03/2022
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Provider Practice Location Address
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Address Line | 4206 N MAIN ST
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City | COLUMBIA
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State | SC
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Zip | 29203-5864
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Country | US
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Telephone | 803-786-2121
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Fax | 803-786-2124
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Provider Business Mailing Address
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Address Line | PO BOX 3788
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City | COLUMBIA
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State | SC
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Zip | 29230-3788
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Country | US
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Telephone | 803-733-5969
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Fax | 803-217-0026
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Authorized Official
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Title or Position | CEO
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Name | DELGADO CANTAVE
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Credential |
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Telephone | 803-733-5969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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