SHELLY D THEOBALD (NPI# 1386078418) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386078418 |
| Entity Type | Individual |
| Full Name | SHELLY D THEOBALD |
| Credential | MD |
| Practice Address |
301 Cedar St Orofino ID 83544-9029 |
| Practice Telephone | 0824764555 |
| Practice Fax Number | 2084765385 |
| Mailing Telephone | 2084764555 |
| Mailing Fax Number | 2084765385 |
| Enumeration Date | 2013-08-26 |
| Last Update Date | 2020-03-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | M-15041 | ID | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | ML60390210 | WA | Allopathic & Osteopathic Physicians |
| Street Address |
301 CEDAR ST |
| City | OROFINO |
| State | ID |
| Zip Code | 83544-9029 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659376010 | Peter W Crecelius | Family Medicine | 301 Cedar St, Orofino, ID 83544-9029 | 2005-06-14 |
| 1891308201 | Daniel Burton | Occupational Therapist | 301 Cedar St, Orofino, ID 83544-9029 | 2020-08-25 |
| 1598391492 | Luke Matzen | Physical Therapist | 301 Cedar St, Orofino, ID 83544-9029 | 2020-03-23 |
| 1750804209 | Rana Janine Cleary | Technician | 301 Cedar St, Orofino, ID 83544-9029 | 2017-07-17 |
| 1467901330 | Taresa Lynn Michna | Nurse Practitioner | 301 Cedar St, Orofino, ID 83544-9029 | 2016-10-03 |
| 1982073946 | Clearwater Valley Hospital and Clinics, Inc | General Acute Care Hospital | 301 Cedar St, Orofino, ID 83544-9029 | 2015-09-21 |
| 1285018754 | Orofino Health Center | Family Medicine | 301 Cedar St, Orofino, ID 83544-9029 | 2015-07-15 |
| 1922414408 | Tammy Jo Miller | Nurse Practitioner | 301 Cedar St, Orofino, ID 83544 | 2014-07-07 |
| 1982028437 | Rachell Larsen | Dietitian, Registered | 301 Cedar St, Orofino, ID 83544-9029 | 2014-02-04 |
| 1679869325 | Rebecca Susan Katzman | Family Medicine | 301 Cedar St, Orofino, ID 83544-9029 | 2011-06-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598229809 | Clearwater Canyon Pharmacy, LLC | Pharmacy | 13020 Us-12, Orofino, ID 83544 | 2019-01-31 |
| 1295130698 | Brian Shapiro | Marriage & Family Therapist | 155 Main Street Stuite C, Orofino, ID 83544 | 2014-10-28 |
| 1942497052 | Jean M. Shropshire | Speech-Language Pathologist | 123 1st St., Orofino, ID 83544 | 2007-10-02 |
| 1417161969 | Jeffrey David Hartshorn | Chiropractor | 437 College Avenue, Orofino, ID 83544 | 2007-05-10 |
| 1598808099 | Orofino Physical Therapy and Wellness Inc | Physical Medicine & Rehabilitation | 1005 Michigan Ave, Orofino, ID 83544 | 2007-02-14 |
| 1083766356 | Adam C. Dayley, O.d., P.C. | Optometrist | 906 Michigan Ave., Orofino, ID 83544 | 2007-01-17 |
| 1710037882 | Douglas L Frank | Pharmacist | 1105 Michigan Avenue, Orofino, ID 83544 | 2007-01-11 |
| 1386718047 | Irene Lamberti | Chiropractor | 437 College Ave., Orofino, ID 83544 | 2006-11-17 |
| 1730281064 | Clearwater County | Ambulance | 1195 Riverside Avenue, Orofino, ID 83544 | 2006-09-05 |
| 1538101050 | Wendi Rene Richardson | Nurse Anesthetist, Certified Registered | 301 Cedar, Clearwater Valley Hospital, Orofino, ID 83544 | 2006-06-11 |
| Find all providers in zip 83544 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659376010 | Peter W Crecelius | Family Medicine | 301 Cedar St, Orofino, ID 83544-9029 | 2005-06-14 |
| 1922453414 | Jennifer Johnston | Family Medicine | 1055 Riverside Ave, Orofino, ID 83544 | 2016-05-03 |
| 1285018754 | Orofino Health Center | Family Medicine | 301 Cedar St, Orofino, ID 83544-9029 | 2015-07-15 |
| 1679869325 | Rebecca Susan Katzman | Family Medicine | 301 Cedar St, Orofino, ID 83544-9029 | 2011-06-21 |
| 1780978320 | Ann Lima | Family Medicine | 301 Cedar St, Orofino, ID 83544-9029 | 2011-05-31 |
| 1770813917 | Colleen Patricia Devine Sholar | Family Medicine | 301 Cedar St, Orofino, ID 83544-9029 | 2010-01-11 |
| 1861669988 | Kimberly Jordan Campbell | Family Medicine | 301 Cedar St, Orofino, ID 83544-9029 | 2008-05-08 |
| 1801089834 | John Seth Lukens | Family Medicine | 301 Cedar St, Orofino, ID 83544-9029 | 2007-08-23 |
| 1619173143 | Joshua J Morris | Family Medicine | 301 Cedar St, Orofino, ID 83544-9029 | 2007-06-22 |
| 1578646345 | Clayton James Bunt | Family Medicine | 301 Cedar St, Clearwater Valley Hospital & Clinics, Orofino, ID 83544-9029 | 2006-10-23 |
| Find all providers in OROFINO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.