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Organization

CUSTOM HEALTHCARE, LLC

Active
Other names
PPS Orthotic & Prosthetic Services
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JAMES C ROGERS II (CEO)
(423) 697-0057
Entity
Organization

Contact information

Practice address
3700 BRAINERD RD STE 134, CHATTANOOGA, TN 37411-3603
(423) 697-0057
(423) 648-9366
Mailing address
3700 BRAINERD RD, CHATTANOOGA, TN 37411-3603
(423) 697-0057
(423) 648-9366

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
1036
TN
332BC3200X
Customized Equipment (DME)
1036
TN
332BX2000X
Oxygen Equipment & Supplies (DME)
3347
TN
335E00000X
Prosthetic/Orthotic Supplier
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000973794C
GA
05
003113634A
GA
05
003199235A
GA
05
05130009
MS
05
1455062
TN
05
7100162230
KY
Enumeration date
05/12/2006
Last updated
04/12/2022
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