CUSTOM HEALTHCARE LLC (NPI# 1316268105) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316268105 |
| Entity Type | Organization |
| Organization Name | CUSTOM HEALTHCARE LLC |
| Practice Address |
1540 Gober Rd Bishop GA 30621-1685 |
| Practice Telephone | 7062071039 |
| Mailing Telephone | 7062071039 |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2010-06-16 |
| Authorized Official Name | DR. TROY ALLEN HEIDESCH (CEO/ PROVIDER) |
| Authorized Official Telephone | 7062071039 |
| Authorized Official Credential | DNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| Street Address |
1540 GOBER RD |
| City | BISHOP |
| State | GA |
| Zip Code | 30621-1685 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821583477 | Kao, LLC | Clinic/Center | 1181 Langford Dr, Bld 100 Suite 101, Watkinsville, GA 30621 | 2018-06-26 |
| 1619262946 | Mauree Harper Whitaker | Nurse Practitioner | 1250 Overlook Ridge Rd, Bishop, GA 30621-1148 | 2011-06-15 |
| 1588090153 | Michael Tate Azzolin | Pharmacist | 1500 Lane Creek Dr, Bishop, GA 30621-1188 | 2013-09-16 |
| 1730582966 | Oconee County Health & Rehabilitation LLC | Skilled Nursing Facility | 3450 New High Shoals Rd, Bishop, GA 30621-1305 | 2014-10-02 |
| 1033619580 | Matthew Edward Osbourn | Occupational Therapy Assistant | 3450 New High Shoals Rd, Bishop, GA 30621-1305 | 2018-02-20 |
| 1043346166 | Britt Alger | Specialist/Technologist | 1131 Creekstone Ln, Bishop, GA 30621-1351 | 2007-02-25 |
| 1184938318 | Teresa Traut | Physical Therapist | 1061 Southwind Dr, Bishop, GA 30621-1361 | 2010-07-29 |
| 1033574553 | Rachel Garrett | Speech-Language Pathologist | 1121 Hardigree Bell Rd, Bishop, GA 30621-1451 | 2015-12-29 |
| 1205462645 | Be The Change Therapy, LLC | Speech-Language Pathologist | 1121 Hardigree Bell Rd, Bishop, GA 30621-1451 | 2020-03-17 |
| 1134114291 | Susan Marcantonio | Pharmacist | 1441 Arborwood Rdg, Bishop, GA 30621-1536 | 2005-09-14 |
| Find all providers in zip 30621 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
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| 1174154496 | Meridian Corporate Healthcare of Georgia P C | Clinic/Center | 2305 Abutment Rd, Dalton, GA 30721-4881 | 2020-01-27 |
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| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.