MEDICARE: SOUTHERN ORTHOCARE INC

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	335E00000X	Prosthetic/Orthotic Supplier	936	TN

General Provider Information

NPI Number	:	1215134986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN ORTHOCARE INC

Provider Business Mailing Address
First Line	:	622 W 1ST NORTH ST
Second Line	:
City	:	MORRISTOWN
State	:	TN
Zip	:	37814-4544
Country	:	US
Telephone Number	:	423-307-1890
Fax Number	:	423-307-1891

Provider Business Practice Location Address
First Line	:	622 W 1ST NORTH ST
Second Line	:
City	:	MORRISTOWN
State	:	TN
Zip	:	37814-4544
Country	:	US
Telephone Number	:	423-307-1890
Fax Number	:	423-307-1891

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOSEPH T HUNTSMAN JR.
Credential	:	MBA, MA, BA, BM
Telephone Number	:	423-307-1890

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	06/17/2026

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