Organization
CHARLES S THEOFILOS MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIRENDIA SHACKELFORD (MANAGED CARE SPEC ALLSCRIPTS)
(800) 654-0889
Entity
Organization
Contact information
Practice address
THE SPINE CENTER, 11621 KEW GARDENS AVE STE 101, PALM BEACH GARDENS, FL 33410
(561) 630-3870
(561) 630-3680
Mailing address
THE SPINE CENTER, 11621 KEW GARDENS AVE STE 101, PALM BEACH GARDENS, FL 33410
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
ME64328
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1014276
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/14/2006
Last updated
08/22/2020
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