| Eau Claire Cooperative Health Center, Inc. | |
|
3800 N Main St Ste. C Columbia SC 29203-6414 | |
| (803) 705-3169 | |
| (803) 705-3175 |
| Full Name | Eau Claire Cooperative Health Center, Inc. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3800 N Main St, Columbia, South Carolina |
| Authorized Official Name and Position | Delgaod Cantave (CEO) |
| Authorized Official Contact | 8037335969 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eau Claire Cooperative Health Center, Inc. Po Box 3788 Columbia SC 29230-3788 Ph: (803) 733-5969 | Eau Claire Cooperative Health Center, Inc. 3800 N Main St Ste. C Columbia SC 29203-6414 Ph: (803) 705-3169 |
| NPI Number | 1457740789 |
|---|---|
| Provider Enumeration Date | 01/09/2015 |
| Last Update Date | 02/03/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457740789 | NPI | - | NPPES |
| ZA9183 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Secondary |
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