Custom Care Medical, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

BL5564340 Issued in PA

Legal business name

CUSTOM CARE MEDICAL, LLC

Practice address

463 E Main Ave
Myerstown, PA 17067-2226

Phone

(717) 272-4967

Fax

(717) 564-3135

NPI assigned

Feb 20, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Eva Kunz, ADMINISTRATOR

Title

Billing Administrator

Phone

(717) 564-0564

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277251200000",
    "number": "1710022678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "463 E MAIN AVE",
            "city": "MYERSTOWN",
            "state": "PA",
            "postal_code": "170672226",
            "telephone_number": "717-272-4967",
            "fax_number": "717-564-3135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "463 E MAIN AVE",
            "city": "MYERSTOWN",
            "state": "PA",
            "postal_code": "170672226",
            "telephone_number": "717-272-4967",
            "fax_number": "717-564-3135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM CARE MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2010-06-23",
        "status": "A",
        "authorized_official_last_name": "KUNZ",
        "authorized_official_first_name": "EVA",
        "authorized_official_title_or_position": "BILLING ADMINISTRATOR",
        "authorized_official_telephone_number": "717-564-0564",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "ADMINISTRATOR"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "BL5564340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lexi Rae Camp
• Jonathan Robert Clark, PHARMD
• Annika Christine Colon, DPT, PT
• Michael M Conrad, OTR/L
• Sharea Lynn Cottle
• Ulanda R Davis, PHD, ND
• Kaitlyn Marie Day
• Eastern Lebanon County School District
• Sundus Saad Mohamed Elfadil, M.D.
• Robert Eugene England Jr., PA

• Family Medicine Physician in Myerstown, PA
• Providers in Myerstown, PA by specialty
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.