Southern Orthopedics and Sports Medicine, LLC

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

SOUTHERN ORTHOPEDICS AND SPORTS MEDICINE, LLC

Practice address

851 Leonard Fulghum Blvd
Suite 101
Mt Pleasant, SC 29464-3787

Phone

(843) 971-9350

Fax

(843) 971-9351

NPI assigned

Aug 27, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Michael Kyle Burtnett

Title

SVP of Outpatient Services, Tenet

Phone

(469) 893-2153

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466640000000",
    "number": "1053568428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "851 LEONARD FULGHUM BLVD",
            "address_2": "SUITE 101",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294643787",
            "telephone_number": "843-971-9350",
            "fax_number": "843-971-9351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "851 LEONARD FULGHUM BLVD",
            "address_2": "SUITE 101",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294643787",
            "telephone_number": "843-971-9350",
            "fax_number": "843-971-9351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ORTHOPEDICS AND SPORTS MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-27",
        "last_updated": "2016-06-23",
        "status": "A",
        "authorized_official_last_name": "BURTNETT",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "KYLE",
        "authorized_official_title_or_position": "SVP OF OUTPATIENT SERVICES, TENET",
        "authorized_official_telephone_number": "469-893-2153",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207PS0010X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Emergency Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP5001",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Orthopaedic Surgery Physician in Mount Pleasant, SC
• Providers in Mount Pleasant, SC by specialty
• Orthopaedic Surgery Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.