MEDICARE: TAILOR MADE OUTREACH COMPANY 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
1	261QM1300X	Multi-Specialty Clinic/Center	1000000020165	TN
2	253J00000X	Foster Care Agency
3	261QR0400X	Rehabilitation Clinic/Center		TN
4	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750817003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAILOR MADE OUTREACH COMPANY LLC

Provider Business Mailing Address
First Line	:	4107 HIXSON PIKE
Second Line	:	SUITE 101
City	:	CHATTANOOGA
State	:	TN
Zip	:	37415-3130
Country	:	US
Telephone Number	:	704-649-4374
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 HIGGINS AVE STE 108
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37920-3006
Country	:	US
Telephone Number	:	704-649-4374
Fax Number	:	865-999-4961

Authorized Official
Title or Position	:	CEO
Name	:	SHANAIREA M CAMP
Credential	:
Telephone Number	:	704-649-4374

Provider Enumeration Date	:	05/05/2017
Last Update Date	:	07/21/2022

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Directions to “TAILOR MADE OUTREACH COMPANY LLC ” Practice Location

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