Organization
CUSTOM HEALTHCARE, LLC
Active
Other names
PPS Orthotic & Prosthetic Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES C ROGERS (CEO)
(423) 697-0057
Entity
Organization
Contact information
Practice address
2150 N OCOEE ST STE C, CLEVELAND, TN 37311-3936
(423) 559-0013
(423) 559-2442
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
—
—
332BC3200X
Customized Equipment (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000973794C
—
GA
05
—
1507472
—
TN
Enumeration date
01/11/2007
Last updated
08/22/2019
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