MEDICARE: SOUNDSIDE ORTHOTICS & PROSTHETICS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)
2	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1184369761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUNDSIDE ORTHOTICS & PROSTHETICS, LLC

Provider Business Mailing Address
First Line	:	1421 S GLENBURNIE RD STE D
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28562-2603
Country	:	US
Telephone Number	:	252-638-1312
Fax Number	:	252-631-1859

Provider Business Practice Location Address
First Line	:	2309 WAYNE MEMORIAL DR
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-1725
Country	:	US
Telephone Number	:	919-778-8844
Fax Number	:	252-631-1859

Authorized Official
Title or Position	:	CEO
Name	:	MR. JOSEPH HUNTSMAN
Credential	:
Telephone Number	:	252-638-1312

Provider Enumeration Date	:	04/28/2022
Last Update Date	:	06/17/2026

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