CHARLES S THEOFILOS MD (NPI# 1760408611) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760408611 |
| Entity Type | Organization |
| Organization Name | CHARLES S THEOFILOS MD |
| Practice Address |
The Spine Center 11621 Kew Gardens Ave Ste 101 Palm Beach Gardens FL 33410 |
| Practice Telephone | 5616303870 |
| Practice Fax Number | 5616303680 |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DIRENDIA SHACKELFORD (MANAGED CARE SPEC ALLSCRIPTS) |
| Authorized Official Telephone | 8006540889 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | ME64328 | FL | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OTHER ID NUMBER-COMMERCIAL NUMBER | 1014276 | 01 |
| Street Address |
THE SPINE CENTER 11621 KEW GARDENS AVE STE 101 |
| City | PALM BEACH GARDENS |
| State | FL |
| Zip Code | 33410 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811501026 | Vicky Pauline Salazar | Registered Nurse | 11501 N Military Trail, Palm Beach Gardens, FL 33410 | 2020-09-04 |
| 1417596388 | Chavon E Mayer | Doula | 149 Winter Park Lane, West Palm Beach, FL 33410 | 2019-12-24 |
| 1639711617 | Diamond Physical Therapy, LLC | Physical Therapist | 4025 Johnson Dairy Road, Palm Beach Gardens, FL 33410 | 2019-10-11 |
| 1689151714 | Caroline Devries Hesterman | Occupational Therapist | 9840 Alternate A1a Ste 402, Palm Beach Gardens, FL 33410 | 2018-07-21 |
| 1366937088 | Krystal Maya Khemkaran | Behavior Technician | 2979 Pga Blvd # 200, Palm Beach Gardens, FL 33410 | 2018-06-25 |
| 1548762552 | Arsenia Pomperada Sabusap | Nurse Practitioner | Grace Medical Center of Florida, 4212 Northlake Blvd., Palm Beach Gardens, FL 33410 | 2018-03-06 |
| 1538668199 | Alan Seidenfeld | Dentist | 7305 N Military Trl 3a-200, Riviera Beach, FL 33410 | 2018-02-08 |
| 1407361454 | Nuvista Living At Jupiter, LLC | Skilled Nursing Facility | 338 Pioneer Road, Jupiter, FL 33410 | 2017-12-12 |
| 1083125728 | Tom Long Biddle-xing | Nurse Practitioner | 3345 Burns Rd Ste 206, Palm Beach Gardens, FL 33410 | 2017-10-20 |
| 1801315189 | Kasie Sidman | Physical Therapist | 3929 Bluebell St, Palm Beach Gardens, FL 33410 | 2017-09-18 |
| Find all providers in zip 33410 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689289993 | South Dade Primary Care, LLC. | Non-Pharmacy Dispensing Site | 3345 Burns Rd Ste 302, Palm Beach Gardens, FL 33410-4321 | 2020-09-14 |
| 1912325846 | Palm Beach Orthopaedic Institute, Pa | Non-Pharmacy Dispensing Site | 4215 Burns Rd Ste 100, Palm Beach Gardens, FL 33410-4627 | 2014-03-28 |
| 1528492675 | Steven Svabek, Do | Non-Pharmacy Dispensing Site | 3375 Burns Rd, Suite 108, Palm Beach Gardens, FL 33410-4349 | 2013-08-26 |
| 1245663467 | Naveed Shafi, Md | Non-Pharmacy Dispensing Site | 3375 Burns Rd, Suite 108, Palm Beach Gardens, FL 33410-4349 | 2013-08-12 |
| 1053606541 | Apollo Medical Management | Non-Pharmacy Dispensing Site | 3365 Burns Rd, #217 Prabhavathi, Palm Beach Gardens, FL 33410-4326 | 2011-06-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821699232 | Orlando Dermatology Clinic LLC | Non-Pharmacy Dispensing Site | 118 W Orange St, Altamonte Springs, FL 32714-2537 | 2020-11-03 |
| 1447857339 | Chen Neighborhood Medical Centers of South Florida, LLC | Non-Pharmacy Dispensing Site | 2445 Nw 62nd St, Miami, FL 33147-7740 | 2020-10-05 |
| 1437765823 | South Miami Hospital, Inc | Non-Pharmacy Dispensing Site | 1228 S Pine Island Rd Ste 110, Plantation, FL 33324-4402 | 2020-09-21 |
| 1407460223 | Daisy Lomadilla Boyer | Non-Pharmacy Dispensing Site | 11703 Holly Creek Dr, Riverview, FL 33569-3356 | 2020-08-31 |
| 1760091078 | West Kendall Baptist Hospital, Inc. | Non-Pharmacy Dispensing Site | 14591 Sw 26th St, Miami, FL 33175-8038 | 2020-07-23 |
| 1821615436 | South Miami Hospital, Inc | Non-Pharmacy Dispensing Site | 8400 Nw 53rd St Ste F106, Doral, FL 33166-4519 | 2020-06-30 |
| 1295358422 | Ezze Pharma LLC | Non-Pharmacy Dispensing Site | 3105 Nw 107th Ave Ste 400, Doral, FL 33172-2215 | 2020-05-21 |
| 1871115436 | Kempcare Inc. | Non-Pharmacy Dispensing Site | 840 Us Highway 1 Ste 435c, N Palm Beach, FL 33408-3829 | 2020-05-17 |
| 1427670595 | Orlando Dermatology Clinic, LLC | Non-Pharmacy Dispensing Site | 3261 Us Highway 441/27 Ste F1, Fruitland Park, FL 34731-4495 | 2020-05-12 |
| 1518593177 | Dedicated Senior Medical Center of Florida, LLC | Non-Pharmacy Dispensing Site | 2724 N Hiawassee Rd Ste 100, Orlando, FL 32818-3008 | 2020-03-16 |
| Find all providers with the same taxonomy | ||||
| City | PALM BEACH GARDENS |
| Zip Code | 33410 |
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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.