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General NPI Number Information
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NPI Number | 1063050862
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Entity Type | Organization
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Legal Business Name | SOUTHERN PROSTHETIC CARE LLC
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Dates
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Enumeration Date | 12/12/2019
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 4410 W RAILROAD ST
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City | GULFPORT
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State | MS
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Zip | 39501
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Country | US
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Telephone | 228-265-7847
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Fax | 228-265-7876
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Provider Business Mailing Address
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Address Line | 4410 W RAILROAD ST
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City | GULFPORT
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State | MS
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Zip | 39501
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Country | US
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Telephone | 228-265-7847
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Fax | 228-265-7876
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Authorized Official
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Title or Position | OWNER
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Name | MR. WILLIAM J KENNY
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Credential | CP
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Telephone | 228-265-7847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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