Provider Demographics
NPI:1154568640
Name:SOUTHERN ORTHOCARE INC
Entity type:Organization
Organization Name:SOUTHERN ORTHOCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:HUNTSMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MBA, MA
Authorized Official - Phone:423-307-1890
Mailing Address - Street 1:2102 E ANDREW JOHNSON HWY
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-5412
Mailing Address - Country:US
Mailing Address - Phone:423-307-1890
Mailing Address - Fax:423-307-1891
Practice Address - Street 1:1567 N EASTMAN RD
Practice Address - Street 2:SUITE 4
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-2683
Practice Address - Country:US
Practice Address - Phone:423-247-0032
Practice Address - Fax:423-247-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5936020003Medicare NSC