NPIMap

Organization Active NPI

Custom Healthcare

Doing business as PPS Infusion Pharmacy

  • Home Infusion Agency
  • Chattanooga, TN
National Provider Identifier
1891868204
Registry record updated Mar 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Infusion AgencyTaxonomy code 251F00000X
License
73387 Issued in TN
Legal business name
CUSTOM HEALTHCARE
Doing business as
PPS Infusion Pharmacy
Practice address
6227 Lee Highway
Suite I
Chattanooga, TN 37421
Phone
(423) 893-9335
Fax
(423) 893-9336
NPI assigned
Nov 15, 2006
Last updated
Mar 8, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2019

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

Authorized official

Name
Wanda S Key, RN
Title
President of Operations
Phone
(423) 697-0057

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Infusion Agency 251F00000X 73387 TN Primary

Addresses

Primary practice location

6227 Lee Highway
Suite I
Chattanooga, TN 37421

Mailing address

3700 Brainerd Rd
Chattanooga, TN 37411-3603
Phone (423) 697-0057

Other identifiers 1

IdentifierTypeStateIssuer
1452932MedicaidTN

Other names 1

  • PPS Infusion Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Custom Healthcare12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6227 Lee Hwy
Ste I
Chattanooga, TN 37421
Phone (423) 893-9335

NPI Registry JSON

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552003200000",
    "number": "1891868204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3700 BRAINERD RD",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374113603",
            "telephone_number": "423-697-0057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6227 LEE HIGHWAY",
            "address_2": "SUITE I",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "37421",
            "telephone_number": "423-893-9335",
            "fax_number": "423-893-9336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2019-03-08",
        "status": "A",
        "authorized_official_last_name": "KEY",
        "authorized_official_first_name": "WANDA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT OF OPERATIONS",
        "authorized_official_telephone_number": "423-697-0057",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": "TN",
            "license": "73387",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1452932",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PPS Infusion Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PPS Infusion Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chattanooga, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2019; 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.