MEDICARE: SPECIALTY ORTHOPEDIC GROUP TENNESSEE PLLC

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	207X00000X	Orthopaedic Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457998379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALTY ORTHOPEDIC GROUP TENNESSEE PLLC

Provider Business Mailing Address
First Line	:	PO BOX 81
Second Line	:
City	:	CASTALIAN SPRINGS
State	:	TN
Zip	:	37031-0081
Country	:	US
Telephone Number	:	615-237-5431
Fax Number	:	615-237-5411

Provider Business Practice Location Address
First Line	:	602 RED BOILING SPRINGS RD STE 106
Second Line	:
City	:	LAFAYETTE
State	:	TN
Zip	:	37083-1316
Country	:	US
Telephone Number	:	615-237-5410
Fax Number	:	615-237-5411

Authorized Official
Title or Position	:	BUSINESS OWNER
Name	:	BEAU CASSIDY
Credential	:	FNP-C
Telephone Number	:	615-237-5410

Provider Enumeration Date	:	12/10/2019
Last Update Date	:	04/07/2025

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