EAU CLAIRE COOPERATIVE HEALTH CENTER INC. (NPI# 1669029294) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669029294 |
| Entity Type | Organization |
| Organization Name | EAU CLAIRE COOPERATIVE HEALTH CENTER INC. |
| Other Organization Name | LITTLE MOUNTAIN PEDIATRICS AND FAMILY PRACTICE |
| Practice Address |
99 N Mill St Little Mountain SC 29075-8788 |
| Mailing Address |
Po Box 3788 Columbia SC 29230-3788 |
| Practice Telephone | 8039451005 |
| Mailing Telephone | 8037335969 |
| Enumeration Date | 2019-08-19 |
| Last Update Date | 2020-09-01 |
| Authorized Official Name | DELGADO CANTAVE (CEO) |
| Authorized Official Telephone | 8037335969 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Little Mountain Family Health Center | Doing Business As Name - Organization |
| Little Mountain Pediatrics and Family Practice | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235753914 | Eau Claire Cooperative Health Center Inc. | Clinic/Center | 4605 Monticello Rd Bldg C, Columbia, SC 29203-4156 | 2020-05-29 |
| 1295202356 | Eau Claire Cooperative Health Center Inc. | Clinic/Center | 2600 Wheat St, Columbia, SC 29205-2315 | 2018-10-26 |
| 1730669789 | Eau Claire Cooperative Health Center Inc. | Pharmacy | 3041 Old Eastover Road, Eastover, SC 29044 | 2018-08-20 |
| 1538674254 | Eau Claire Cooperative Health Center Inc. | Clinic/Center | 407 N Brown St, West Columbia, SC 29169-5710 | 2017-12-04 |
| 1306185509 | Eau Claire Cooperative Health Center Inc. | Clinic/Center | 1228 Harden St, Ste.b, Columbia, SC 29204-1800 | 2013-02-07 |
| Street Address |
99 N MILL ST |
| City | LITTLE MOUNTAIN |
| State | SC |
| Zip Code | 29075-8788 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598731556 | Michelle G Archer | Family Medicine | 99 N Mill St, Little Mountain, SC 29075-8788 | 2006-02-28 |
| 1912426248 | Tamara S Riley | Nurse Practitioner | 99 N Mill St, Little Mountain, SC 29075-8788 | 2017-09-19 |
| 1588078042 | Lauren M Powell | Nurse Practitioner | 99 N Mill St, Little Mountain, SC 29075-8788 | 2014-06-12 |
| 1891138970 | Annette Burden | Nurse Practitioner | 99 N Mill St, Little Mountain, SC 29075-8788 | 2013-04-09 |
| 1417182783 | Newberry County Memorial Hospital | Clinic/Center | 99 N Mill St, Little Mountain, SC 29075-8788 | 2009-05-15 |
| 1831140094 | Newberry Family Heatlh Center | Family Medicine | 99 N Mill St, Little Mountain, SC 29075-8788 | 2006-05-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760490528 | John M Thompson | Internal Medicine | 99 N. Mill Street, Little Mountian, SC 29075 | 2006-08-04 |
| 1720425069 | Sally B Dominick | Registered Nurse | 692 Mill St, Little Mountain, SC 29075-8716 | 2013-05-28 |
| 1821522913 | Kayla Price | Prevention Professional | 1942 Old Dutch Rd, Little Mountain, SC 29075-8870 | 2017-04-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821522913 | Kayla Price | Prevention Professional | 1942 Old Dutch Rd, Little Mountain, SC 29075-8870 | 2017-04-14 |
| 1720425069 | Sally B Dominick | Registered Nurse | 692 Mill St, Little Mountain, SC 29075-8716 | 2013-05-28 |
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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|---|---|---|---|---|
| 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 | ||||
| City | LITTLE MOUNTAIN |
| Zip Code | 29075 |
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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.