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General NPI Number Information
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NPI Number | 1558239160
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Entity Type | Organization
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Legal Business Name | CONCIERGE PHYSICIAN SERVICES
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Dates
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Enumeration Date | 10/27/2025
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 569 HEALTH BLVD STE A
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-1499
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Country | US
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Telephone | 386-200-2056
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Fax | 386-275-1776
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Provider Business Mailing Address
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Address Line | 569 HEALTH BLVD STE A
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-1499
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Country | US
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Telephone | 386-200-2056
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Fax | 386-275-1776
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Authorized Official
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Title or Position | PYSICIAN
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Name | THEODORE HASKIN
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Credential | DO
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Telephone | 417-350-9556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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