Healthcare Provider Details

I. General information

NPI: 1790043537
Provider Name (Legal Business Name): SOUTHERN ORTHOCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 N 12TH ST SUITE 250
MIDDLESBORO KY
40965-1835
US

IV. Provider business mailing address

622 W 1ST NORTH ST
MORRISTOWN TN
37814-4544
US

V. Phone/Fax

Practice location:
  • Phone: 606-302-4002
  • Fax: 606-302-4005
Mailing address:
  • Phone: 423-307-1890
  • Fax: 423-307-1891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH HUNTSMAN JR.
Title or Position: CEO/OWNER
Credential:
Phone: 423-307-1890