| Eau Claire Internal Medicine | |
|
4605 Monticello Rd Bldg A, Ste.3 Columbia SC 29203-4156 | |
| (803) 754-0151 | |
| (803) 691-1778 |
| Full Name | Eau Claire Internal Medicine |
|---|---|
| Speciality | Clinic/Center |
| Location | 4605 Monticello Rd, Columbia, 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 Internal Medicine Po Box 3788 Columbia SC 29230-3788 Ph: (803) 733-5969 | Eau Claire Internal Medicine 4605 Monticello Rd Bldg A, Ste.3 Columbia SC 29203-4156 Ph: (803) 754-0151 |
| NPI Number | 1447561527 |
|---|---|
| Provider Enumeration Date | 06/23/2010 |
| Last Update Date | 02/03/2022 |
| Medicare PECOS PAC ID | 3274434220 |
|---|---|
| Medicare Enrollment ID | O20121224000020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447561527 | NPI | - | NPPES |
| FQC031 | Medicaid | SC | |
| FQC141 | Medicaid | SC | |
| CBP018 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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