Provider Demographics
NPI:1356397459
Name:SOUTHEASTERN ORTHOTICS & PROSTHETICS, INC.
Entity type:Organization
Organization Name:SOUTHEASTERN ORTHOTICS & PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SORENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, LPO
Authorized Official - Phone:615-217-9821
Mailing Address - Street 1:PO BOX 305172
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-5172
Mailing Address - Country:US
Mailing Address - Phone:423-266-8892
Mailing Address - Fax:
Practice Address - Street 1:220 1ST ST NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-1306
Practice Address - Country:US
Practice Address - Phone:423-559-0500
Practice Address - Fax:423-559-0541
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEASTER ORTHOTICS & PROSTHETICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-26
Last Update Date:2024-03-26
Deactivation Date:2023-05-31
Deactivation Code:
Reactivation Date:2023-06-26
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0130020003Medicare NSC