Provider Demographics
NPI:1477690782
Name:CAPITAL CITY OB-GYN ASSOCIATES PA
Entity Type:Organization
Organization Name:CAPITAL CITY OB-GYN ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOJMIR
Authorized Official - Middle Name:J
Authorized Official - Last Name:SONEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-254-7004
Mailing Address - Street 1:1301 TAYLOR STREET SUITE 4K
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201
Mailing Address - Country:US
Mailing Address - Phone:803-254-7004
Mailing Address - Fax:803-254-7057
Practice Address - Street 1:1301 TAYLOR STREET SUITE 4K
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201
Practice Address - Country:US
Practice Address - Phone:803-254-7004
Practice Address - Fax:803-254-7057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
SC15829207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0691Medicaid
SCGP0691Medicaid
SC4863Medicare UPIN