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General NPI Number Information
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NPI Number | 1154231892
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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 | 09/08/2026
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Last Update Date | 09/08/2026
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Provider Practice Location Address
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Address Line | 2525 KINARD ST
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City | NEWBERRY
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State | SC
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Zip | 29108-2909
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Country | US
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Telephone | 803-405-0220
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Fax |
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Provider Business Mailing Address
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Address Line | 2525 KINARD ST
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City | NEWBERRY
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State | SC
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Zip | 29108-2909
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Country | US
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Telephone | 803-405-0220
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Fax |
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Authorized Official
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Title or Position | SR. CREDENTIALING SPECIALIST
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Name | KIMBERLY M TILLEY
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Credential |
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Telephone | 803-530-7855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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