Organization
CUSTOM HEALTHCARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES C ROGERS (CEO)
(423) 697-0057
Entity
Organization
Contact information
Practice address
201 CENTER PARK DR STE 1000, KNOXVILLE, TN 37922-2105
(865) 966-4452
(865) 966-4457
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
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1455062
—
TN
Enumeration date
12/08/2011
Last updated
12/08/2011
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