| Eau Claire Behavioral Medicine | |
|
4605 Monticello Rd Building B, Ste.1 Columbia SC 29203-4156 | |
| (803) 714-0266 | |
| (803) 753-6333 |
| Full Name | Eau Claire Behavioral Medicine |
|---|---|
| Speciality | Clinic/Center |
| Location | 4605 Monticello Rd, Columbia, South Carolina |
| Authorized Official Name and Position | Delgado Cantave (CEO) |
| Authorized Official Contact | 8037335969 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eau Claire Behavioral Medicine Po Box 3788 Columbia SC 29230-3788 Ph: (803) 753-5591 | Eau Claire Behavioral Medicine 4605 Monticello Rd Building B, Ste.1 Columbia SC 29203-4156 Ph: (803) 714-0266 |
| NPI Number | 1992018949 |
|---|---|
| Provider Enumeration Date | 07/20/2010 |
| Last Update Date | 02/10/2022 |
| Certification Date | 02/10/2022 |
| Medicare PECOS PAC ID | 3274434220 |
|---|---|
| Medicare Enrollment ID | O20101013000458 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992018949 | NPI | - | NPPES |
| FQC187 | Medicaid | SC | |
| CBP018 | Medicaid | SC | |
| FQC031 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | () | Primary |
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