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General NPI Number Information
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NPI Number | 1891148367
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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 | 07/19/2016
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Last Update Date | 02/10/2022
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Provider Practice Location Address
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Address Line | 8063 EDMUND HWY
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City | PELION
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State | SC
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Zip | 29123-9805
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Country | US
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Telephone | 803-894-3736
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Fax | 803-894-5315
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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 | 803-753-5591
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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