EAU CLAIRE COOPERATIVE HEALTH CENTER INC. NPI 1629381678

NPI Information

NPI: 1629381678
Provider Name: EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.

Doing Business As: BROOKLAND COMMUNITY PEDIATRICS

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
500 N 12TH ST
WEST COLUMBIA, SC
ZIP 29169
Phone: (803) 217-0415
Get Directions

EAU CLAIRE COOPERATIVE HEALTH CENTER, INC. is a federally qualified health center (fqhc) clinic center in West Columbia, SC. EAU CLAIRE COOPERATIVE HEALTH CENTER, INC. NPI is 1629381678. The provider is registered as an organization entity type.
The provider Is Doing Business As Brookland Community Pediatrics.

The provider's business location address is:

500 N 12TH ST
WEST COLUMBIA, SC
ZIP 29169-502
Phone: (803) 217-0415
Fax: (803) 939-1650

The provider's authorized official is Delgado Cantave .
The authorized official title is Ceo and has the following contact phone number (803) 733-5969.

The CLIA number assigned to this NPI record is 42D0956061 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/20/2010 and was last updated on 2/3/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	FQC151	MEDICAID	SOUTH CAROLINA
2	421843	OTHER	SOUTH CAROLINA	GROUP PTAN
3	CBP018	MEDICAID	SOUTH CAROLINA
4	FQC031	MEDICAID	SOUTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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