| Mofdaps And Company | |
|
1203 48th Ave N 202 Myrtle Beach SC 29577-5425 | |
| (843) 449-2576 | |
| (843) 449-6851 |
| Full Name | Mofdaps And Company |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1203 48th Ave N, Myrtle Beach, South Carolina |
| Authorized Official Name and Position | Adedapo Mofolus Oduwole (OWNER) |
| Authorized Official Contact | 8434492576 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mofdaps And Company Po Box 50817 Myrtle Beach SC 29579-0014 Ph: (843) 449-2576 | Mofdaps And Company 1203 48th Ave N 202 Myrtle Beach SC 29577-5425 Ph: (843) 449-2576 |
| NPI Number | 1144458183 |
|---|---|
| Provider Enumeration Date | 06/29/2009 |
| Last Update Date | 10/28/2009 |
| Medicare PECOS PAC ID | 3678611720 |
|---|---|
| Medicare Enrollment ID | O20091110000261 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144458183 | NPI | - | NPPES |
| 34116200 | Medicaid | WI | |
| 31507 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 31507 (South Carolina) | Primary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 43425 (Wisconsin) | Secondary |
| Provider Name | Deborah L Hipp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437258191 PECOS PAC ID: 1456245844 Enrollment ID: I20040209000260 |
| Provider Name | Patsy G Alexander |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609032630 PECOS PAC ID: 2365401700 Enrollment ID: I20041011000056 |
| Provider Name | Adedapo M Oduwole |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720139645 PECOS PAC ID: 2062550114 Enrollment ID: I20091110000244 |
| Provider Name | Karen J Fulwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164414520 PECOS PAC ID: 6608923578 Enrollment ID: I20141124000655 |
| Provider Name | Patricia Ann Montgomery |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699547810 PECOS PAC ID: 7113361270 Enrollment ID: I20240216000126 |
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