| Eau Claire Coopertive Health Center, Inc. | |
|
338 E Columbia Ave Suite B Leesville SC 29070-9285 | |
| (803) 532-1580 | |
| (803) 532-3832 |
| Full Name | Eau Claire Coopertive Health Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 338 E Columbia Ave, Leesville, 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 Coopertive Health Center, Inc. Po Box 3788 Columbia SC 29230-3788 Ph: (803) 733-5969 | Eau Claire Coopertive Health Center, Inc. 338 E Columbia Ave Suite B Leesville SC 29070-9285 Ph: (803) 532-1580 |
| NPI Number | 1336460948 |
|---|---|
| Provider Enumeration Date | 06/17/2010 |
| Last Update Date | 10/10/2022 |
| Medicare PECOS PAC ID | 3274434220 |
|---|---|
| Medicare Enrollment ID | O20120829000090 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336460948 | NPI | - | NPPES |
| 4350 | Other | SC | MEDICARE PART B |
| CBP018 | Medicaid | SC | |
| FQC031 | Medicaid | SC | |
| FQC123 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
B-l Family Practice P A Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 608 E Columbia Ave, Leesville, SC 29070 Phone: 803-532-8155 Fax: 803-532-9685 |