Organization
SOUTHERN PROSTHETIC CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM J KENNY CP (OWNER)
(228) 216-0528
Entity
Organization
Contact information
Practice address
4201 HIGHWAY 11 N STE D, PICAYUNE, MS 39466
(228) 216-0528
(769) 242-2556
Mailing address
4201 HIGHWAY 11 N STE D, PICAYUNE, MS 39466-2014
(228) 216-0528
(769) 242-2556
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
08/22/2017
Last updated
07/21/2022
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