EAU CLAIRE COOPERATIVE HEALTH CENTERS, INC. (NPI# 1841689288) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841689288 |
| Entity Type | Organization |
| Organization Name | EAU CLAIRE COOPERATIVE HEALTH CENTERS, INC. |
| Other Organization Name | LAKE MONTICELLO FAMILY PRACTICE @MCCROREY LISTON |
| Practice Address |
1978 State Highway 215 S Blair SC 29015-9443 |
| Mailing Address |
Po Box 3788 Columbia SC 29230-3788 |
| Practice Telephone | 8034026782 |
| Practice Fax Number | 8036356628 |
| Mailing Telephone | 8037335969 |
| Mailing Fax Number | 8037535591 |
| Enumeration Date | 2015-01-22 |
| Last Update Date | 2016-12-16 |
| Authorized Official Name | DELGADO CANTAVE (CEO) |
| Authorized Official Telephone | 8037335969 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | FQC031 | 05 | |
| SC | FQC180 | 05 | |
| SC | CBP018 | 05 |
| Other Name | Type Code |
|---|---|
| Lake Monticello Family Practice @McCrorey Liston | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760871115 | Eau Claire Cooperative Health Centers, Inc. | Clinic/Center | 2400 Waites Rd, Columbia, SC 29204-1325 | 2015-01-22 |
| 1679962021 | Eau Claire Cooperative Health Centers, Inc. | Family Medicine | 3821 W Beltline Blvd, Columbia, SC 29204-1567 | 2015-01-22 |
| 1700122967 | Eau Claire Cooperative Health Centers, Inc. | Clinic/Center | 6904 N Main St, Suite 100, Columbia, SC 29203-3852 | 2012-12-17 |
| 1952727158 | Eau Claire Cooperative Health Centers, Inc. | Clinic/Center | 2712 Middleburg Dr, Ste. 101, Columbia, SC 29204-2415 | 2014-03-12 |
| 1427494392 | Eau Claire Cooperative Health Centers, Inc. | Clinic/Center | 4801 Monticello Rd, Columbia, SC 29203-4124 | 2013-05-17 |
| 1467795815 | Eau Claire Cooperative Health Centers, Inc. | Clinic/Center | 4605 Monticello Rd, Bldgb, Ste.2, Columbia, SC 29203-4156 | 2013-04-04 |
| 1760703250 | Eau Claire Cooperative Health Centers, Inc. | Clinic/Center | 755 Us Highway 21 S, Ridgeway, SC 29130-6844 | 2010-06-18 |
| 1750555298 | Eau Claire Cooperative Health Centers, Inc. | Clinic/Center | 1332 Pickens St, Columbia, SC 29201-3430 | 2008-04-16 |
| 1558320960 | Eau Claire Cooperative Health Centers, Inc. | Clinic/Center | 1520 Laurel St, Columbia, SC 29201-2623 | 2006-03-23 |
| Street Address |
1978 STATE HIGHWAY 215 S |
| City | BLAIR |
| State | SC |
| Zip Code | 29015-9443 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417929134 | Janet L Douglass | Nurse Practitioner | 12 Meadowlake Rd, Blair, SC 29015-8997 | 2006-02-06 |
| 1730722679 | South Carolina New Beginnings LLC | Community/Behavioral Health | 7251 Road 99, Blair, SC 29015-9205 | 2019-10-23 |
| 1649803370 | Zeneeka Crosby | Speech-Language Pathologist | 3418 State Highway 215 N, Blair, SC 29015-9629 | 2020-02-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235747080 | Mark Allen Kwikkel | Specialist/Technologist | 310 N 10th, Blair, NE 68008 | 2020-07-17 |
| 1063038255 | Brock Bernard Lewis | Dentist | 1904 South St Ste 103, Blair, NE 68008-1964 | 2020-06-23 |
| 1750906046 | Brittany Pleskac | Counselor | 13121 County Road 16, Blair, NE 68008-5674 | 2020-06-11 |
| 1649803370 | Zeneeka Crosby | Speech-Language Pathologist | 3418 State Highway 215 N, Blair, SC 29015-9629 | 2020-02-21 |
| 1710521398 | Michelle Godfrey, LLC | Clinic/Center | 1904 South St Ste 105, Blair, NE 68008-1964 | 2019-11-06 |
| 1215570718 | Erica Garris | Pharmacist | 3570 Golden Eagle Cir, Blair, NE 68008-6703 | 2019-10-28 |
| 1730722679 | South Carolina New Beginnings LLC | Community/Behavioral Health | 7251 Road 99, Blair, SC 29015-9205 | 2019-10-23 |
| 1942851852 | Brittany Miller | Occupational Therapy Assistant | N35590 Weverstad Rd, Blair, WI 54616-8600 | 2019-09-23 |
| 1841845385 | Planned Parenthood of Wisconsin | Non-Pharmacy Dispensing Site | 223 South Main St., Blair, WI 54616 | 2019-08-01 |
| 1326607797 | Blair Blue Cab LLC | Non-emergency Medical Transport (VAN) | 3348 Adams St, Blair, NE 68008-4002 | 2019-06-10 |
| Find all providers in BLAIR | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124627153 | Hopehealth Inc | Clinic/Center | 2155 Paxville Hwy, Manning, SC 29102-5074 | 2020-10-21 |
| 1083228779 | Sandhills Medical Foundation Inc | Clinic/Center | 103 Main Street South, Bethune, SC 29009 | 2020-09-01 |
| 1235753914 | Eau Claire Cooperative Health Center Inc. | Clinic/Center | 4605 Monticello Rd Bldg C, Columbia, SC 29203-4156 | 2020-05-29 |
| 1982248852 | Regenesis Organization Community Health Center | Clinic/Center | 115 Thomas St Ste B, Union, SC 29379-2147 | 2019-11-04 |
| 1720636012 | Genesis Health Care, Inc | Clinic/Center | 115 Exchange St, Darlington, SC 29532-3203 | 2019-08-29 |
| 1063079549 | Health Care Partners of South Carolina, Inc. | Clinic/Center | 243 Singleton Ridge Rd, Units E&f, Conway, SC 29526-8391 | 2019-05-21 |
| 1043775703 | Rural Health Services Inc | Clinic/Center | 4200 Whiskey Rd, Aiken, SC 29803-8534 | 2019-02-07 |
| 1295202356 | Eau Claire Cooperative Health Center Inc. | Clinic/Center | 2600 Wheat St, Columbia, SC 29205-2315 | 2018-10-26 |
| 1215410667 | Low Country Health Care System | Clinic/Center | 19340 Solomon Blatt Ave N, Blackville, SC 29817-2304 | 2018-09-12 |
| 1922584481 | Sandhills Medical Foundation, Inc. | Clinic/Center | 290 Market Street, Ruby, SC 29741 | 2018-07-17 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.