Provider Demographics
NPI:1144458183
Name:MOFDAPS AND COMPANY
Entity type:Organization
Organization Name:MOFDAPS AND COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEDAPO
Authorized Official - Middle Name:MOFOLUS
Authorized Official - Last Name:ODUWOLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-449-2576
Mailing Address - Street 1:PO BOX 50817
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-0014
Mailing Address - Country:US
Mailing Address - Phone:843-449-2576
Mailing Address - Fax:843-449-6851
Practice Address - Street 1:1203 48TH AVE N
Practice Address - Street 2:202
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5425
Practice Address - Country:US
Practice Address - Phone:843-449-2576
Practice Address - Fax:843-449-6851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-29
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI434252084P0800X
SC315072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34116200Medicaid
SC31507Medicaid
WI34116200Medicaid
WI541760287Medicare PIN
SC31507Medicaid