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NPI Code Detail

MEDICARE: CUSTOM HEALTHCARE, LLC

MEDICARE: CUSTOM HEALTHCARE, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies1036TN
2332BX2000XOxygen Equipment & Supplies (DME)3347TN
3332BC3200XCustomized Equipment (DME)1036TN
4335E00000XProsthetic/Orthotic Supplier

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275583783
Entity Type Code : Organization
Provider Name (Legal Business Name) : CUSTOM HEALTHCARE, LLC
Provider Business Mailing Address
First Line : 3700 BRAINERD RD
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37411-3603
Country : US
Telephone Number : 423-697-0057
Fax Number : 423-648-9366
Provider Business Practice Location Address
First Line : 3700 BRAINERD RD STE 134
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37411-3603
Country : US
Telephone Number : 423-697-0057
Fax Number : 423-648-9366
Authorized Official
Title or Position : CEO
Name : MR. JAMES C ROGERS II
Credential :
Telephone Number : 423-697-0057
Provider Enumeration Date : 05/12/2006
Last Update Date : 04/12/2022

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Directions to “CUSTOM HEALTHCARE, LLC ” Practice Location

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