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General NPI Number Information
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NPI Number | 1558320960
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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 | 03/23/2006
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Last Update Date | 02/03/2022
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Provider Practice Location Address
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Address Line | 1520 LAUREL ST
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City | COLUMBIA
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State | SC
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Zip | 29201-2623
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Country | US
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Telephone | 803-799-8407
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Fax | 803-799-8148
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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 | 803-252-5624
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Authorized Official
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Title or Position | CEO
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Name | DR. STUART A. HAMILTON
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Credential | M.D.
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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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