NPIMap

Organization Active NPI

Medogun PA

  • Pediatric Adolescent Medicine Physician
  • Columbia, SC
National Provider Identifier
1376683391
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
21514 Issued in SC
Legal business name
MEDOGUN PA
Practice address
120 Wildewood Park Dr
Suite B
Columbia, SC 29223-4300
Phone
(803) 788-7882
Fax
(803) 788-7818
NPI assigned
Feb 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Mojibola Olayinka Solaja, M.D.NPI 1164487955
Title
Medical Doctor
Phone
(803) 788-7882

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080A0000X 21514 SC Primary

Addresses

Primary practice location

120 Wildewood Park Dr
Suite B
Columbia, SC 29223-4300

Mailing address

120 Wildewood Park Dr
Suite B
Columbia, SC 29223-4300
Phone (803) 788-7882

Other names 1

  • milestones pediatrics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Medogun PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 2

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": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376683391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 WILDEWOOD PARK DR",
            "address_2": "SUITE B",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292234300",
            "telephone_number": "803-788-7882",
            "fax_number": "803-788-7818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 WILDEWOOD PARK DR",
            "address_2": "SUITE B",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292234300",
            "telephone_number": "803-788-7882",
            "fax_number": "803-788-7818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDOGUN PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SOLAJA",
        "authorized_official_first_name": "MOJIBOLA",
        "authorized_official_middle_name": "OLAYINKA",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "803-788-7882",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "SC",
            "license": "21514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "milestones pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.