| Dr Omolola Ajoke Omotoso, MD | |
|
110 Executive Parkway, Moncks Corner, SC 29461 | |
| (843) 899-9099 | |
| (843) 899-9091 |
| Full Name | Dr Omolola Ajoke Omotoso |
|---|---|
| Gender | Female |
| Speciality | Hospitalist |
| Experience | 27 Years |
| Location | 110 Executive Parkway, Moncks Corner, South Carolina |
| Accepts Medicare Assignments | May be. She may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154514529 | NPI | - | NPPES |
| Facility Name | Location | Facility Type |
|---|---|---|
| Hannibal Regional Hospital | Hannibal, MO | Hospital |
| Mercy Hospital Joplin | Joplin, MO | Hospital |
| Tanner Medical Center - Carrollton | Carrollton, GA | Hospital |
| Research Medical Center | Kansas city, MO | Hospital |
| Blessing Hospital | Quincy, IL | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Mercy Clinic Joplin Llc | 0547300196 | 291 |
| Dunn Physician Services Llc | 0345787578 | 46 |
| Apogee Medical Group Georgia | 4587676945 | 125 |
| Hannibal Regional Healthcare System Inc | 1254236300 | 263 |
| Entity Name | Mercy Clinic Springfield Communities |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1245277631 PECOS PAC ID: 7416865845 Enrollment ID: O20031104000060 |
| Entity Name | Hannibal Regional Healthcare System Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1003956095 PECOS PAC ID: 1254236300 Enrollment ID: O20031203000229 |
| Entity Name | Mercy Clinic Springfield Communities |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1972771657 PECOS PAC ID: 7416865845 Enrollment ID: O20031218000354 |
| Entity Name | Physician Groups Lc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1285664268 PECOS PAC ID: 3072421254 Enrollment ID: O20040220001157 |
| Entity Name | Mercy Clinic Joplin Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1215264817 PECOS PAC ID: 0547300196 Enrollment ID: O20091218000092 |
| Entity Name | Cole Physician Services Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1144578659 PECOS PAC ID: 0648420810 Enrollment ID: O20121024000296 |
| Entity Name | Butler Physician Services, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1982056545 PECOS PAC ID: 6608164561 Enrollment ID: O20161007001160 |
| Entity Name | Galen Inpatient Physicians Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1538714688 PECOS PAC ID: 3678464633 Enrollment ID: O20191115000362 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Omolola Ajoke Omotoso, MD Po Box 1116, Moncks Corner, SC 29461-1116 Ph: (843) 899-9099 | Dr Omolola Ajoke Omotoso, MD 110 Executive Parkway, Moncks Corner, SC 29461 Ph: (843) 899-9099 |
Rose Delores Gibbs, MD Internal Medicine Medicare: Medicare Enrolled Practice Location: 106 W Main St, Moncks Corner, SC 29461 Phone: 843-761-1995 Fax: 843-761-3257 | |
Dr. Temisan L Etikerentse, MD Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 110 Executive Pkwy, Moncks Corner, SC 29461 Phone: 843-899-9099 Fax: 843-899-9091 |