Custom Script Infusion Vital Care LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

MP0552402 Issued in WV

Legal business name

CUSTOM SCRIPT INFUSION VITAL CARE LLC

Doing business as

Custom Script Infusion Vital Care

Practice address

3738 Teays Valley Rd
Suite B
Hurricane, WV 25526-9705

Phone

(304) 543-3292

NPI assigned

Mar 25, 2013

Last updated

Dec 8, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Chad A Wallace, R.PH.

Title

VP Operations

Phone

(304) 543-3292

Specialties & licenses 5

Addresses

Other names 1

• Custom Script Infusion Vital Care Doing business as

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

{
    "created_epoch": "1364169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417996800000",
    "number": "1720320088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3738 TEAYS VALLEY RD",
            "address_2": "SUITE B",
            "city": "HURRICANE",
            "state": "WV",
            "postal_code": "255269705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3738 TEAYS VALLEY RD",
            "address_2": "SUITE B",
            "city": "HURRICANE",
            "state": "WV",
            "postal_code": "255269705",
            "telephone_number": "304-543-3292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM SCRIPT INFUSION VITAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-25",
        "last_updated": "2014-12-08",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "CHAD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "VP OPERATIONS",
        "authorized_official_telephone_number": "304-543-3292",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WV",
            "license": "MP0552402",
            "primary": true
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "WV",
            "license": "MP0552402",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "WV",
            "license": "MP0552402",
            "primary": false
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": "WV",
            "license": "MP0552402",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Custom Script Infusion Vital Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Custom Script Pharmacy
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• Tara Leanne Daniels, CRNA
• Daquest Care Transport LTD Co.

• Durable Medical Equipment & Medical Supplies in Hurricane, WV
• Providers in Hurricane, WV by specialty
• Durable Medical Equipment & Medical Supplies in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2014; 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.