SOUTHERN PROSTHETIC CARE LLC NPI 1205352127

NPI Information

  • NPI: 1205352127
  • Provider Name: SOUTHERN PROSTHETIC CARE LLC
  • Classification: Prosthetic/Orthotic Supplier - 335E00000X
  • Entity Type: Organization
  • CLIA Number: 25D2050152
  • Address: 4201 HIGHWAY 11 N STE D
    PICAYUNE, MS
    ZIP 39466
  • Phone: (228) 216-0528

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NPI Details

SOUTHERN PROSTHETIC CARE LLC is a prosthetic orthotic supplier in Picayune, MS. The provider is an organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. SOUTHERN PROSTHETIC CARE LLC NPI is 1205352127. The provider is registered as an organization entity type.

The provider's business location address is:

4201 HIGHWAY 11 N STE D
PICAYUNE, MS
ZIP 39466
Phone: (228) 216-0528
Fax: (769) 242-2556

The provider's authorized official is William J Kenny .
The authorized official title is Owner and has the following contact phone number (228) 216-0528.

The CLIA number assigned to this NPI record is 25D2050152 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/22/2017 and was last updated on 7/21/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1335E00000XProsthetic/Orthotic SupplierYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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