Provider Demographics
NPI:1790043537
Name:SOUTHERN ORTHOCARE INC
Entity Type:Organization
Organization Name:SOUTHERN ORTHOCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
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:423-307-1891
Practice Address - Street 1:705 N 12TH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-1835
Practice Address - Country:US
Practice Address - Phone:606-302-4002
Practice Address - Fax:606-302-4005
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN ORTHOCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-30
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5936020004Medicare NSC