Provider Demographics
NPI:1669040861
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:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNSTMAN
Authorized Official - Suffix:
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:
Practice Address - Street 1:1406 TUSCULUM BLVD STE 2003
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4341
Practice Address - Country:US
Practice Address - Phone:423-657-1400
Practice Address - Fax:423-657-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier