Charles S Theofilos MD

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

ME64328 Issued in FL

Legal business name

CHARLES S THEOFILOS MD

Practice address

The Spine Center
11621 Kew Gardens Ave Ste 101
Palm Beach Gardens, FL 33410

Phone

(561) 630-3870

Fax

(561) 630-3680

NPI assigned

Jul 14, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Direndia Shackelford

Title

Managed Care Spec Allscripts

Phone

(800) 654-0889

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Charles S Theofilos, M.D. P.A.

  • Neurological Surgery Physician
  • Palm Beach Gardens, FL
  • NPI 1861444846
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1760408611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "THE SPINE CENTER",
            "address_2": "11621 KEW GARDENS AVE STE 101",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "33410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "THE SPINE CENTER",
            "address_2": "11621 KEW GARDENS AVE STE 101",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "33410",
            "telephone_number": "561-630-3870",
            "fax_number": "561-630-3680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES S THEOFILOS MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHACKELFORD",
        "authorized_official_first_name": "DIRENDIA",
        "authorized_official_title_or_position": "MANAGED CARE SPEC ALLSCRIPTS",
        "authorized_official_telephone_number": "800-654-0889"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "FL",
            "license": "ME64328",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "1014276",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ingreed Champagne
• Ashaunda Amanda Chapman, BA
• Geoffrey Alan Chappell, P.T.
• Charles E Ahner M D P a
• Charles H Etheredge DMD PA (Restassured Sleep Centers)
• Charles S. Theofilos MD PA (The Spine Center)
• Makepeace B Charles, D.D.S.
• Peterson Charles
• Edwiana Charlot
• Chaiyapat Charoonbara, MD

• Non-Pharmacy Dispensing Site in Palm Beach Gardens, FL
• Providers in Palm Beach Gardens, FL by specialty
• Non-Pharmacy Dispensing Site in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.