| Eau Claire Developmental Clinic | |
|
4601 Monticello Road Columbia SC 29203 | |
| (803) 356-7102 | |
| (803) 356-7106 |
| Full Name | Eau Claire Developmental Clinic |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 4601 Monticello Road, Columbia, South Carolina |
| Authorized Official Name and Position | Kimberly Tilley (CREDENTIALING MANAGER) |
| Authorized Official Contact | 8043061203 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eau Claire Developmental Clinic Po Box 3788 Columbia SC 29230-3788 Ph: (803) 733-5969 | Eau Claire Developmental Clinic 4601 Monticello Road Columbia SC 29203 Ph: (803) 356-7102 |
| NPI Number | 1023407996 |
|---|---|
| Provider Enumeration Date | 01/15/2015 |
| Last Update Date | 06/24/2026 |
| Certification Date | 06/24/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023407996 | NPI | - | NPPES |
| CBP018 | Medicaid | SC | |
| FQC031 | Medicaid | SC | |
| FQC181 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (NU) | Primary |
| 2080P0006X | Pediatrics - Developmental - Behavioral Pediatrics | (NU) | Secondary |
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