Provider Demographics
NPI:1467168047
Name:SOUTHERN ORTHOCARE INC
Entity Type:Organization
Organization Name:SOUTHERN ORTHOCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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:
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:423-453-5354
Practice Address - Street 1:2022 CHILHOWEE MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5285
Practice Address - Country:US
Practice Address - Phone:865-855-9701
Practice Address - Fax:865-855-9702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-26
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies