NPIMap

Organization Active NPI

Eau Claire Cooperative Health Center, Inc.

Doing business as Lake Monticello Family Practice @McCrorey Liston

  • Federally Qualified Health Center (FQHC)
  • Blair, SC
National Provider Identifier
1841689288
Registry record updated Feb 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Doing business as
Lake Monticello Family Practice @McCrorey Liston
Practice address
1978 State Highway 215 S
Blair, SC 29015-9443
Phone
(803) 402-6782
Fax
(803) 635-6628
NPI assigned
Jan 22, 2015
Last updated
Feb 10, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Delgado Cantave
Title
Ceo
Phone
(803) 733-5969

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1978 State Highway 215 S
Blair, SC 29015-9443

Mailing address

PO Box 3788
Columbia, SC 29230-3788
Phone (803) 733-5969

Other identifiers 3

IdentifierTypeStateIssuer
CBP018MedicaidSC
FQC031MedicaidSC
FQC180MedicaidSC

Other names 1

  • Lake Monticello Family Practice @McCrorey Liston Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Eau Claire Coop HLTH Ctr44 organizations share this tax ID, including this one

Other organizations with this tax ID 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

Locations

1978 State Highway 215 S
Blair, SC 29015
Phone (803) 402-6782

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1421884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644451200000",
    "number": "1841689288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3788",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292303788",
            "telephone_number": "803-733-5969",
            "fax_number": "803-753-5591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1978 STATE HIGHWAY 215 S",
            "city": "BLAIR",
            "state": "SC",
            "postal_code": "290159443",
            "telephone_number": "803-402-6782",
            "fax_number": "803-635-6628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-22",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A",
        "authorized_official_last_name": "CANTAVE",
        "authorized_official_first_name": "DELGADO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "803-733-5969"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CBP018",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FQC031",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FQC180",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Monticello Family Practice @McCrorey Liston",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Monticello Family Practice @McCrorey Liston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blair, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.