NPIMap

Organization Active NPI

Mofdaps and Company

  • Psychiatry Physician
  • Myrtle Beach, SC
National Provider Identifier
1144458183
Registry record updated Oct 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
31507 Issued in SC
Legal business name
MOFDAPS AND COMPANY
Practice address
1203 48TH Ave N
202
Myrtle Beach, SC 29577-5425
Phone
(843) 449-2576
Fax
(843) 449-6851
NPI assigned
Jun 29, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2009

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

Authorized official

Name
Dr. Adedapo Mofolus Oduwole, M.D.NPI 1720139645
Title
Owner
Phone
(843) 449-2576

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 31507 SC Primary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 43425 WI

Addresses

Primary practice location

1203 48TH Ave N
202
Myrtle Beach, SC 29577-5425

Mailing address

PO Box 50817
Myrtle Beach, SC 29579-0014
Phone (843) 449-2576

Other identifiers 2

IdentifierTypeStateIssuer
34116200MedicaidWI
31507MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091110000261 SC Part B Supplier - Clinic/Group Practice 3678611720 Receives reassigned benefits from 9 practitioners
Practice locations: Myrtle Beach, SC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1246233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256688000000",
    "number": "1144458183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50817",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295790014",
            "telephone_number": "843-449-2576",
            "fax_number": "843-449-6851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 48TH AVE N",
            "address_2": "202",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295775425",
            "telephone_number": "843-449-2576",
            "fax_number": "843-449-6851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOFDAPS AND COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-29",
        "last_updated": "2009-10-28",
        "status": "A",
        "authorized_official_last_name": "ODUWOLE",
        "authorized_official_first_name": "ADEDAPO",
        "authorized_official_middle_name": "MOFOLUS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-449-2576",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "SC",
            "license": "31507",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WI",
            "license": "43425",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34116200",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31507",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.